CONTINUOUS ARTERIOVENOUS HEMOFILTRATION AND RESPIRATORY-FUNCTION IN MULTIPLE ORGAN SYSTEMS FAILURE

OBJECTIVE: To determine what change in respiratory function occurred following prolonged and efficient continuous arteriovenous haemofiltration (CAVH) in a group of patients with multiple organ systems failure (MOSF). DESIGN: A retrospective assessment using patient notes and ICU charts. SETTING: The Intensive Care Unit of a large University Teaching Hospital. PATIENTS: All ICU patients satisfying the following criteria: (i) Failure of more than one organ system; (ii) Treatment with CAVH; (iii) Removal of more than 10 l of ultrafiltrate per day; (iv) Continuous haemofiltration for at least 5 days. Thirteen patients satisfied these criteria and 14 episodes of CAVH were analyzed. MEASUREMENTS: All data were recorded from the patient notes and ICU charts apart from the A-aDO2 and PaO2/FiO2 (PF) ratio which were calculated from available values. A mean of 3.5 different organ systems failed during the period of stay. The mean daily ultrafiltrate volume obtained was 23.7 (SD 0.95) l and the mean duration of treatment 9.6 (SD 4.3) days. Significant improvements occurred in the values for the PF ratio and ventilatory modality (p < 0.05), and the FiO2 and A-aDO2 (p = 0.001). The mean PEEP value remained unchanged at 4.8 cmH2O. Ten of the 13 patients subsequently died (77% mortality). CONCLUSIONS: A significant improvement in respiratory function occurred in patients with MOSF who had undergone a prolonged period of intensive CAVH. Haemofiltration may therefore be a useful treatment for respiratory failure in this patient group. Unfortunately the overall mortality of the group remained high.