Impact of Different Types of Resuscitation Fluids on Coagulation and Continuous Venovenous Hemofiltration Hemocompatibility in a Porcine Model
: Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substi...
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Published in | Therapeutic apheresis and dialysis Vol. 17; no. 5; pp. 510 - 523 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Australia
Blackwell Publishing Ltd
01.10.2013
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Subjects | |
Online Access | Get full text |
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Summary: | :
Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substitutes are known to influence hemorheology and coagulation. To define a potential net effect of volume substitutes on the hemocompatibility of an RRT, we chose an animal model without interfering pathophysiologies. According to the problem of early filter failure and coagulation disorders in critically ill patients, we focused on the hypothesized interaction between RRT and different volume substitutes with respect to blood cell counts, coagulation parameters and required heparin dose. Forty‐eight pigs were assigned to four groups of fluid therapy with either normal saline (NaCl), 6%HES130kD/0.4 (HES130), 6%HES200kD/0.5 (HES200) or 4%gelatin (GEL). Six pigs of each fluid group underwent continuous venovenous hemofiltration (CVVH), the remaining six served as the control group. Anticoagulation was performed with continuous heparin infusion. CVVH was run in a recirculation‐mode for 4.5 h to force hemocompatibility reactions, thereafter in a standard‐mode for 2 h. During the CVVH‐treatment GEL reduced platelet counts and fibrinogen concentration and additionally lowered ATIII levels. Heparin requirements did not differ between different volume substitutes or CVVH and control groups. Severe pathophysiologies are not the only reason for a reduced hemocompatibility of CVVH treatment. Interaction of a particular volume substitute with CVVH should be considered when interpreting study results and evolving new strategies. |
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Bibliography: | Fresenius Kabi Deutschland GmbH, Bad Homburg Gambro Dialysatoren, Hechingen istex:77AF4C9D2F3E6E16B7EB75E5F89991B936830C95 Else Kröner-Fresenius-Stiftung ark:/67375/WNG-43TWPXL4-0 ArticleID:TAP12014 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1744-9979 1744-9987 |
DOI: | 10.1111/1744-9987.12014 |