[Hemofiltration as therapy in acute pulmonary failure in cardiogenic shock]

In 29 cardiosurgical patients in cardiogenic shock after extracorporal circulation complicated by acute pulmonary failure, it was impossible to restore normal postoperative arterial oxygen tension, in-spite of optimal pharmacotherapy and ideal conditions with a conventional volume-controlled respirator. These patients were subject to continuous arteriovenous haemofiltration; in all of them the start of haemofiltration immediately led to a significant reduction of respiratory oxygen supply with an increase in arterial oxygen tension. Pulmonary shunt volume decreased. At the same time there was an increase in arteriovenous oxygen difference, arterial oxygen content and oxygen transport capacity. Pulmonary artery pressure as well as pulmonary vascular resistance decreased noticeably, whereas there was an increase in total peripheral vascular resistance. Starting haemofiltration with decreasing left ventricular filling pressure, accompanied by a rise in blood pressure and an increase in total peripheral resistance, led to an improvement of the haemodynamic situation as well as pulmonary oxygen diffusion, thereby ensuring oxygen perfusion of peripheral tissue. The results suggest a causal relation between the improvement of the clinical condition of the patient and the elimination of cardiopulmonary toxic agents like myocardial depressant factor (MDF) and shock mediators due to arteriovenous haemofiltration.