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The effect of a hemofilter during extracorporeal circulation on hemodynamics in patients with SIRS
1Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan. yk119@kitasato-u.ac.jp
Objective:
To evaluate the hypothesis that extracorporeal hemopurification with a hemofilter contributes to the stabilization of hemodynamics in patients with systemic inflammatory response syndrome (SIRS) due to a mechanism other than the removal of cytokines.
Design:
Prospective study.
Setting:
Intensive care unit (ICU) in a university hospital.
Patients:
Seven critically ill patients who met criteria for SIRS with unstable hemodynamics requiring vasopressors after emergency surgery.
Interventions:
Before initiation of continuous hemofiltration (CHF) extracorporeal circulation through the hemofilter (ECC) with a hollow-fiber polyacrylonitrile hemofilter was performed for 6 h.
Measurements And Results:
Vital signs were monitored continuously and hemodynamics were evaluated intermittently. The blood level of endotoxin and the plasma levels of cytokines were measured at 0 and 6 h. Changes in plasma levels of cytokines passing through the hemofilter were evaluated at 3 h. A significant decrease of body temperature (P < 0.05 at 3 and 6 h vs 0 h), a significant elevation of mean arterial pressure (P < 0.05 at 0.5 h, P < 0.01 at 3 and 6 h vs 0 h), and a significant increase of urinary flow rate (P < 0.05 at 0 to 3 h vs -3 to 0 h) were observed with ECC. Neither the blood level of endotoxin nor the plasma levels of cytokines decreased. A significant increase of plasma IL-6 as it passed through the hemofilter was noted.
Conclusions:
The beneficial effects of hemopurification with a hemofilter on SIRS patients are possibly due to mechanisms other than the elimination of cytokines with ultrafiltration, diffusion, or adsorption.