INFLUENCE OF CONTINUOUS HEMOFILTRATION ON THE HEMODYNAMICS OF TRAUMA PATIENTS

Background. The aim of this prospective randomized controlled study wa s to investigate the effects of continuous venovenous hemofiltration o n the hemodynamics and respiratory function of critically ill trauma p atients with multiple organ dysfunction syndrome. Methods. Thirty cons ecutive critically ill, mechanically ventilated trauma patients with m ultiple organ dysfunction syndrome (without kidney failure) who had in vasive hemodynamic monitoring for management of hypotension or hypoxem ia were randomized to treatment with or without continuous venovenous hemofiltration. Hemodynamics profile was recorded immediately before a nd at 6, 12, 24, and 48 hours after the hemofiltration was started (me an of three set data each time). No changes in ventilatory parameters were performed during-the study. Results. Thirty patients were analyze d (15 with and 15 without hemofiltration). Both groups were similar in age (36 +/- 18 versus 36 +/- 14 years) and severity scores (Injury Se verity Score, 32 +/- 16 versus 30 +/- 11; Acute Physiology and Chronic Health Evaluation II score, 22 +/- 77 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 art erial blood/inspiratory oxygen supply index (123 +/- 40 to 204 +/- 44, P = 0.03) in the intervention group during the study period. We did n ot find any other significant change in variables studied. Conclusions . Continuous venovenous hemofiltration is associated with a significan t improvement in hemodynamic and respiratory variables in critically i ll trauma patients with multiple organ dysfunction syndrome. This impr ovement can help in the management of these patients. Further work is necessary to define whether this technique can reduce the high mortali ty of this disease.