[Clinical evaluation of hemofiltration in perioperative medicine]

Haemofiltration (HF) in perioperative period is used in order to improve the function of circulatory system by means of: elimination of cytokines in patients with increased inflammatory cascade activation; improvement of gas exchange conditions by decreasing the amount of lungs extravascular fluid; reduction of high levels of metabolism products; compensation of electrolyte disequilibrium and decreasing of right ventricle afterload as well as right and left ventricles preload. The aim of the study was clinical evaluation of usefulness of continuous vein-to-vein haemofiltration (CVVH) technique used in multiprofile adults intensive care. The analysis included 20 patients aged 24-73 (mean age 48.5), treated with HF in 1998-1999. HF was introduced in the following clinical conditions: multiorgan trauma with ARDS, acute pancreatitis with multiple organ dysfunction syndrome (MODS), peritonitis, status after laparotomy and chronic circulatory failure in patients qualified to heart transplantation. In six patients (30%), significant improvement of general state and stabilisation of haemodynamic and ventilation parameters were obtained. In fourteen patients (70%), despite CVVH, no improvement of circulatory and respiratory systems state was obtained. HF is very useful technique employed in perioperative medicine. It enables improvement of gas exchange conditions by decreasing the amount of lungs extravascular fluid in patients with ARDS in the course of MODS. HF simplyfies preparation the patient with chronic circulatory failure for diagnostic and therapeutic cardiosurgical procedures. In the course of sepsis and septic shock, HF creates better prospects to nutritional therapy and replaces haemodialysis or is its continuation.