[Pulmonary gas exchange function during hemofiltration in patients with multiple organ failure]

Pulmonary gas exchange was examined in 37 patients with multiple organ failure in the course of long forced ventilation of the lungs (FVL) and hemofiltration (HF). Acute respiratory distress syndrome (ARDS) was observed in 25 (65.7%) patients. Assessment of the effect of HF on the lungs for the entire group and for patients with ARDS showed no changes in the pulmonary gas exchange function in the course of 24-hour HF. On the other hand, during the first 7-8 h of HF the oxygenation function of the lungs either improved (group 1, n = 11) or deteriorated (group 2, n19). In group 1 the paO2 reliably (by 36%) increased, paO2/FiO2 increased by 36%, (A-a)O2 reliably (16%) dropped, as did the Os/Ot (by 30%) during 7-8 hours. In group 2 PaO2 decreased by 14%, PaO2/FiO2 by 16%, and the oxygen index (O2I) increased by 24% (p < 0.05), these values remaining at levels requiring no more intensive respiratory support or other intensive care. Gas exchange function of the lungs was studied in 18 patients in the course of isotonic dehydration. The pulmonary capillaries wedge pressure dropped by 25%, central venous pressure by 18% in the course of dehydration. Changes in other values were unreliable. Due to decrease of extracellular hyperhydration the alveolar-arterial O2 gradient dropped by 17.5% and the intrapulmonary shunt by 21% (p < 0.05). Oxygen tension in the arterial blood remained the same in the group in general.