Influence of zero-balanced hemofiltration on the course of severe experimental pancreatitis in pigs

Objective To examine the impact of continuous venovenous hemofiltration (CV VH) on the course of experimental pancreatitis in pigs. Summary Background Data The activation of different mediator cascades is as sumed to trigger multiple organ dysfunction pr failure during necrotizing p ancreatitis. CVVH has been suggested to be beneficial in those instances by eliminating several inflammatory mediators released in the circulation. Methods Pancreatitis was induced by a combined intraductal injection of sod ium taurocholate and enterokinase. Control group animals received no treatm ent after induction. A second group underwent "therapeutic" CVVH after a 20 % decline of mean arterial pressure. In the third group, "prophylactic" CVV H was started simultaneously with the induction of pancreatitis. The concen trations of tumor necrosis factor-alpha, transforming growth factor-beta,, kinin, and phospholipase A, were measured at different time points in blood (pre- and postfilter) and in the hemofiltrate to calculate the respective sieving coefficients that reflect most accurately the plasma clearance of m ediators by CVVH. Results Survival time was significantly prolonged both by therapeutic and p rophylactic CVVH; it was more pronounced in the latter. CVVH did not influe nce the increase in transforming growth factor concentrations. However, 6 h ours after induction, the increases of plasma concentrations of tumor necro sis factor, phospholipase, and kinin were significantly weakened by CVVH co mpared with controls. In the treatment groups, the plasma concentrations of tumor necrosis factor and phospholipase showed a significant negative corr elation with the respective sieving coefficients, which decreased in the la ter course of the experiments. Conclusions Experimental necrotizing pancreatitis was associated with a tre mendous increase of plasma concentrations of tumor necrosis factor, phospho lipase, and kinin. The effective removal of these mediators by CVVH resulte d in significantly improved survival time. Animals that received prophylact ic CVVH had a longer survival period than those in which CVVH was started a fter clinical impairment. The decreasing efficiency of CVVH in eliminating inflammatory mediators in the later course of the experiments suggested tha t the filter membranes were compromised by long-term application. These fin dings provide further evidence that CVVH offers therapeutic options even in the absence of conventional indications for blood-purifying treatments.