EFFICACY OF CONTINUOUS ARTERIOVENOUS HEMOFILTRATION IN ENDOTOXIC-SHOCK

We determined the efficacy of continuous arteriovenous hemofiltration (CAVH) in removing tumor necrosis factor (TNF), thromboxane A2, and pr ostacyclin, and in improving survival in endotoxemia. Twelve rats were given 10 mg/kg of E. coil 0:127:88 lipopolysaccharide. Fifteen min la ter, the rats were randomized to ultrafiltered or non-ultrafiltered gr oups. Blood and ultrafiltrate were collected for TNF, thromboxane B2 ( TxB2), and 6-keto-prostaglandin F1 alpha (G-keto-PGF1 alpha). After 4 hr, surviving rats were sacrificed. Five of 6 ultrafiltered and none o f 6 non-ultrafiltered rats survived 4 hr. Plasma TxB2 >1,000 pcg/ml an d its rate of increase within the first 2 hr predicted death (P < 0.03 ). Ultrafiltration decreased the rate of rise in TxB2 (P < 0.04). Plas ma TxB2 inversely correlated with TxB2 clearance by ultrafiltration. T he concentration and rate of increase in TNF and 6-keto-PGF1 alpha did not predict survival. We conclude that CAVH improves short term survi val in endotoxemia. Salutary effects appear to be due to thromboxane A 2 removal. (C) 1995 Wiley-Liss, Inc.