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Prophylactic hemofiltration in severely traumatized patients: effects on post-traumatic organ dysfunction syndrome
M Bauer1, I Marzi, T Ziegenfuss
1Klinik für Anaesthesiologie und Intensivmedizin, Universität des Saarlandes, Kirrberger Strasse, 66421 Homburg/Saar, Germany. aimbau@med-rz.uni-sb.de
Intensive Care Medicine
|June 9, 2001
Summary
Prophylactic continuous veno-venous hemofiltration (CVVH) in trauma patients did not improve overall organ dysfunction but blunted cardiovascular response. However, CVVH significantly decreased platelet counts, limiting its use in surgical patients.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Nephrology
Background:
- Severe multiple trauma can lead to multiple organ dysfunction syndrome (MODS).
- Continuous veno-venous hemofiltration (CVVH) is a renal replacement therapy that may influence systemic inflammatory response and organ function.
- The role of prophylactic CVVH in non-renal failure trauma patients is not well-defined.
Purpose of the Study:
- To evaluate the effects of prophylactic CVVH on MODS in severe multiple trauma patients without renal failure.
- To assess the impact of CVVH on systemic hemodynamics and organ-specific dysfunction.
Main Methods:
- Prospective, randomized study in a university hospital intensive care unit.
- 24 severe multiple trauma patients (ISS > 27) without renal failure were randomized.
- 12 patients received conventional treatment; 12 received isovolemic CVVH for 5 days within 24 hours of trauma.
Main Results:
- Prophylactic CVVH did not alter overall MODS severity (MOF, APACHE II scores).
- CVVH attenuated the hyperdynamic circulatory response, increasing cardiac output and systemic vascular resistance.
- CVVH led to a more pronounced decrease in platelet counts compared to controls.
Conclusions:
- Prophylactic CVVH blunts the cardiovascular response to severe trauma and enhances tissue oxygen extraction.
- The significant decrease in platelet counts is a major limitation for using prophylactic CVVH in surgical trauma patients.