CYTOKINE PATTERNS IN PATIENTS WHO UNDERGO HEMOFILTRATION FOR TREATMENT OF MULTIPLE ORGAN FAILURE

The excessive uncontrolled activation of inflammatory cells and mediat ors after trauma or major surgery plays a key role in the development of adult respiratory distress syndrome and multiple organ system failu re (MOSF), In the past elevated cytokine levels were shown to influenc e the outcome of these patients adversely. There are diverging results regarding the removal of circulating cytokines by various methods of hemopurification for clinical improvement of MOSF. Seven patients afte r trauma or major surgery underwent continuous venovenous hemofiltrati on (CVVH) for the treatment of severe organ failure of the heart and l ungs (Murray score 2.74) but not for renal or liver failure, The cytok ine levels were measured at the beginning and 15, 60, 120, and 240 min utes after initiation of CVVH (measure points MP1-5), Clinical improve ment during the treatment was monitored, and correlation with cytokine levels was evaluated. Arterially measured tumor necrosis factor or ro se from 11.14 ng/ml to 17.86 ng/ml (p < 0.05), Arterial interleukin-6 (IL-6) levels significantly decreased during CVVH from 1284.7 ng/ml to 557.9 ng/ml; IL-8 levels simultaneously decreased from an initial pea k of up to 154.4 ng/ml at MP3 to 97.3 ng/ml at MP5. The drop in serum IL-6 and IL-8 levels closely correlated with clinical improvement, Aft er 2 hours of CVVH the hemodynamic situation improved significantly, a s revealed by a decrease in catecholamine expenditure, an increase in arterial pressure, and a decrease in pulmonary artery pressure. Moreov er, 2 hours after the initiation of CVVH the oxygenation index rose si gnificantly and correlated well with the drop in shunt fraction. The M urray score significantly fell to 1.86. The removal of IL-6 and IL-8 b y CVVH after initial stimulation correlates with clinical improvement, which was demonstrated by significantly improved oxygenation and hemo dynamics from 2 hours after the initiation of CVVH onward. The elimina tion of cytokines and several mediators by CVVH may contribute to the cardiopulmonary improvement of critically ill patients. In comparison with the clinical control group (n = 7), which was comparable in terms of MOSF, no intervention led to a similar improvement in cardiorespir atory failure, and overall two of these patients died. Moreover, patie nts of the control group experienced a significant longer stay at in t he intensive care unit.