Influence of continuous hemofiltration on the hemodynamics of trauma patients.

BACKGROUND: The aim of this prospective randomized controlled study was to investigate the effects of continuous venovenous hemofiltration on the hemodynamics and respiratory function of critically ill trauma patients with multiple organ dysfunction syndrome.

METHODS: Thirty consecutive critically ill, mechanically ventilated, trauma patients with multiple organ dysfunction syndrome (without kidney failure) who had invasive hemodynamic monitoring for management of hypotension or hypoxemia were randomized to treatment with or without continuous venovenous hemofiltration. Hemodynamics profile was recorded immediately before and at 6, 12, 24, and 48 hours after the hemofiltration was started (mean of three set data each time). No changes in ventilatory parameters were performed during the study.

RESULTS: Thirty patients were analyzed (15 with and 15 without hemofiltration). Both groups were similar in age (36 +/- 18 versus 36 +/- 14 years) and severity scores (Injury Severity Score, 32 +/- 16 versus 30 +/- 11; Acute Physiology and Chronic Health Evaluation II score, 22 +/- 7 versus 21 +/- 6; Goris score, 5.2 +/- 1.7 versus 5.2 +/- 1.8) and received similar inotropic support. We found a significant improvement in mean arterial pressure (80 +/- 9 to 94 +/- 8 (mm Hg), p = 0.01) and partial pressure of oxygen in arterial blood/inspiratory oxygen supply index (124 +/- 40 to 204 +/- 44, p = 0.03) in the intervention group during the study period. We did not find any other significant change in variables studied.

CONCLUSIONS: Continuous venovenous hemofiltration is associated with a significant improvement in hemodynamic and respiratory variables in critically ill trauma patients with multiple organ dysfunction syndrome. This improvement can help in the management of these patients. Further work is necessary to define whether this technique can reduce the high mortality of this disease.