Continuous Renal Replacement Therapy Improves Septic Shock in Patients Unresponsive to Early Goal-Directed Therapy
Koji Goto*, Seigo Hidaka, Takakuni Abe, Ryo Shitomi, Norihisa Yasuda, Shunsuke Yamamoto, Satoshi Hagiwara and Takayuki Noguchi
Department of Anesthesiology and Intensive Care, Oita University, 1-1 Idaigaoka, Hasama, Yuhu, Oita 879-5593, Japan
- *Corresponding Author:
- Koji Goto
Department of Anesthesiology and Intensive Care
Oita University Hospital
1-1 Idaigaoka, Hasama
Yuhu, Oita 879-5593, Japan
E-mail: [email protected]
Received date: April 02, 2011; Accepted date: August 29, 2011; Published date: September 09, 2011
Citation: Goto K, Hidaka S, Abe T, Shitomi R, Yasuda N, et al. (2011) Continuous Renal Replacement Therapy Improves Septic Shock in Patients Unresponsive to Early Goal-Directed Therapy. J Anesthe Clinic Res 2:161. doi: 10.4172/2155-6148.1000161
Copyright: © 2011 Goto K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Early goal-directed therapy (EGDT) has been shown to improve patient outcomes. Treatment of patients unresponsive to the protocol, however, is difficult and the result is occasionally fatal. Recently, continuous renal replacement therapy (CRRT) has been used to treat acute kidney injury (AKI) to improve survival. We examined the effectiveness of CRRT in treating septic shock patients with concurrent AKI who are not amenable to EGDT.
Methods: We studied 17 patients who underwent emergency surgery for intra-abdominal infection; these patients experienced AKI complications and did not respond to EGDT within 6 hrs after intensive care unit (ICU) admission. We treated patients with continuous venovenous hemodiafiltration (CVVHDF; dialysis = 900 ml/hr, filtration = 900 ml/hr, total hemopurification = 1800 ml/hr). We measured mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2), catecholamine index (CAI), and determined serum concentrations of lactate, interleukin-6 (IL-6), and high mobility group box-1 protein (HMGB-1) immediately before and 3, 6, 12, 24, 48 hrs after CRRT initiation. We also evaluated 28-day survival, ICU survival, and hospital survival.
Results: CRRT duration was 6.5±4.2 days. MAP and ScvO2 significantly increased with CRRT, while CAI and concentrations of lactate, IL-6, and HMGB-1 significantly decreased. After CRRT, no patients required intermittent hemodialysis in the ICU. Mean ICU stay was 15.1±10.4 days. ICU survival, 28-day survival, and hospital survival were 76.5%, 76.5%, and 70.6%, respectively.
Conclusions: CRRT may be an effective treatment for seriously ill patients who have complications of AKI and are unresponsive to EGDT.