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Comparación de la hemofiltración continua impulsada por bomba y la espontánea en la insuficiencia renal aguda

M Storck¹, W H Hartl, E Zimmerer

¹Department of Surgery, Ludwig-Maximilians University of Munich, Germany.

Lancet (London, England)

|February 23, 1991

Resumen

La hemofiltración impulsada por bomba (PDHF) mostró una tasa de supervivencia más alta que la hemofiltración arteriovenosa continua espontánea (CAVH) en pacientes quirúrgicos con insuficiencia renal aguda. El PDHF logró una mayor eliminación de líquidos, probablemente al eliminar más mediadores tóxicos.

Área de la Ciencia:

Nefrología Nefrología.
Medicina de cuidados intensivos Medicina de cuidados intensivos
Cuidados quirúrgicos de cuidados críticos quirúrgicos.

Sus antecedentes:

La insuficiencia renal aguda (IRA) es una complicación común en las unidades quirúrgicas de cuidados intensivos.
La hemofiltración continua es un tratamiento clave para la FRA, siendo los métodos comunes la hemofiltración arteriovenosa continua espontánea (CAVH) y la hemofiltración impulsada por bomba (PDHF).
La elección entre CAVH y PDHF puede afectar los resultados de los pacientes.

Objetivo del estudio:

Para comparar la eficacia y los resultados de CAVH y PDHF en pacientes con FRA posquirúrgica.
Para evaluar las diferencias en las tasas de supervivencia, el control de la uremia y la necesidad de hemodiálisis adicional entre los dos métodos de hemofiltración.

Principales métodos:

Un estudio comparativo en el que participaron 116 pacientes con FRA posquirúrgica ingresados en una unidad quirúrgica de cuidados intensivos.
Los pacientes fueron asignados a CAVH (n=48) o PDHF (n=68) en función de la disponibilidad de la bomba.
Los puntos finales clave incluyeron la tasa de supervivencia, el control de la uremia y los requisitos de hemodiálisis.

Principales resultados:

Tanto CAVH como PDHF manejaron eficazmente la uremia y la sobrecarga de líquidos.
PDHF demostró una tasa de supervivencia significativamente mayor en comparación con CAVH (12,5% frente a 29,4%, p <0,05).
El volumen diario de ultrafiltrado fue significativamente mayor con PDHF (15,7 L/día) que con CAVH (7,0 L/día), lo que se correlaciona con la supervivencia en FRA inducida por sepsis isquémica o por sepsis.

Conclusiones:

La PDHF se asocia con mejores tasas de supervivencia en pacientes con ARF posquirúrgico en comparación con CAVH.
Los mayores volúmenes de eliminación de líquidos con PDHF pueden contribuir a mejores resultados, potencialmente a través de una mayor eliminación de mediadores tóxicos.
Los hallazgos sugieren que el PDHF puede ser una estrategia de hemofiltración superior para pacientes quirúrgicos en estado crítico con FRA.

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