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The influence of haemodialysis on haemodynamic measurements using transpulmonary thermodilution in patients with septic shock: an observational study.
MedLine Citation:
PMID:  22935958     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
CONTEXT: Patients with sepsis frequently present with acute renal failure requiring intermittent renal replacement therapy and haemodynamic monitoring. To date, the effect of haemodialysis on PiCCO monitoring has not been determined. OBJECTIVE: To determine the effect of haemodialysis on the measurement of haemodynamic variables using transpulmonary thermodilution. DESIGN: Prospective observational study. SETTING: Medical ICU in a university hospital. PATIENTS: Thirty patients with sepsis and acute renal failure undergoing intermittent haemodialysis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Cardiac index, global end-diastolic volume index and extravascular lung water index measured with or without haemodialysis. RESULTS: Significant correlations were found for all variables measured with and without haemodialysis (r = 0.55 to 0.91, P < 0.01). Measurements of cardiac index without and with haemodialysis were significantly different [4.71 vs. 4.18 l min m, difference -0.54 (SD 0.70), 95% confidence interval (CI) -0.80 to -0.28; P < 0.01], as were values of global end-diastolic volume index without and with haemodialysis [864.8 vs. 775.3 ml m, difference -89.5 (SD 191.8), 95% CI -161.2 to -17.9; P = 0.02]. Measurements of extravascular lung water index without and with haemodialysis did not differ significantly [10.3 vs. 10.0 ml kg, difference -0.3 (SD 2.0), 95% CI -1.1 to 0.5; P = 0.42]. CONCLUSION: Although significant correlations were found for cardiac index, global end-diastolic volume index and extravascular lung water index with and without haemodialysis, cardiac index and global end-diastolic volume index were significantly reduced during haemodialysis, but not extravascular lung water index, when measured by the PiCCO system in patients with septic shock. Although differences were small, the variability of within-patient differences may be clinically important and care should be taken in relying solely on such measurements.
Authors:
Anita Pathil; Wolfgang Stremmel; Vedat Schwenger; Christoph Eisenbach
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-29
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  -     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Gastroenterology and Hepatology (AP, WS, CE), Department of Nephrology, University of Heidelberg, Heidelberg, Germany (VS).
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