Large-pore hemodialysis in acute endotoxin shock

Jeffrey Kline, Brian E. Gordon, Cliff Williams, Susan Blumenthal, John A. Watts, José Diaz-Buxo

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: This study was undertaken to test the hypothesis that hemodialysis with a large-pore membrane would improve heart function during acute endotoxin shock. Setting: Large animal laboratory. Design: Eighteen mongrel dogs were instrumented to measure left ventricular maximum end- systolic elastance (left ventricular maximum elastance at end systole), cardiac output, circumflex artery blood flow, and myocardial mechanical efficiency (CO x MAP/MVO2, where CO is cardiac output, MAP is mean arterial pressure, and MVO2 is myocardial oxygen consumption). Plasma catecholamine concentrations were determined by high-performance liquid chromatography. Endotoxin shock was induced by infusing 5.0 μg/kg/min of Escherichia coli 0127:B8 endotoxin in the portal vein for 60 mins, followed by 2.0 μg/kg/min of constant infusion. Control dogs (n = 6) received 4.0 mL/kg/min of saline; hemodialysis dogs (n = 6) underwent venovenous hemodialysis in 50-min intervals using a polysulfone filter (1.2 m2; mean pore size, 0.50 nm; blood flow rate, 400 mL/min; ultrafiltrate, 'zero-balanced'); shams (n = 5) were treated identically to hemodialysis dogs, except that no convective dialysis was performed. A fourth group (n = 6) was treated with dopamine (5.0-7.0 μg/kg/min, optimal dose for contractile increase based on dose-response studies). Measurements and Main Results: After 2 hrs of treatment, left ventricular maximum elastance at end systole increased and was unchanged in controls (30 ± 5 mm Hg/mm) and shams (24 ± 6 mm Hg/mm) compared with basal control. Hemodialysis treatment increased contractility (53 ± 4 mm Hg/mm), as did dopamine treatment (54 ± 7 mm Hg/mm). Endotoxin shock reduced mechanical efficiency to 45% of basal control; with hemodialysis treatment, left ventricular efficiency returned to 64% of basal control measurement, compared with 49% with dopamine treatment. During treatment, myocardial glucose uptake was increased with hemodialysis compared with other groups. No difference was observed among groups for left ventricular end-diastolic pressures or dimensions, or catecholamine concentrations. Conclusions: Large- pore hemodialysis increased left ventricular contractility to a similar degree as dopamine and provided a marginal improvement in myocardial glucose uptake and mechanical efficiency.

Original languageEnglish (US)
Pages (from-to)588-596
Number of pages9
JournalCritical Care Medicine
Volume27
Issue number3
StatePublished - 1999
Externally publishedYes

Fingerprint

Endotoxins
Renal Dialysis
Shock
Dopamine
Dogs
Systole
Carbon Monoxide
Cardiac Output
Catecholamines
Therapeutics
Glucose
Laboratory Animals
Portal Vein
Oxygen Consumption
Dialysis
Arterial Pressure
Arteries
High Pressure Liquid Chromatography
Escherichia coli
Blood Pressure

Keywords

  • Endotoxin shock
  • Hemodialysis
  • Hemofiltration
  • Ventricular contractility

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Kline, J., Gordon, B. E., Williams, C., Blumenthal, S., Watts, J. A., & Diaz-Buxo, J. (1999). Large-pore hemodialysis in acute endotoxin shock. Critical Care Medicine, 27(3), 588-596.

Large-pore hemodialysis in acute endotoxin shock. / Kline, Jeffrey; Gordon, Brian E.; Williams, Cliff; Blumenthal, Susan; Watts, John A.; Diaz-Buxo, José.

In: Critical Care Medicine, Vol. 27, No. 3, 1999, p. 588-596.

Research output: Contribution to journalArticle

Kline, J, Gordon, BE, Williams, C, Blumenthal, S, Watts, JA & Diaz-Buxo, J 1999, 'Large-pore hemodialysis in acute endotoxin shock', Critical Care Medicine, vol. 27, no. 3, pp. 588-596.
Kline J, Gordon BE, Williams C, Blumenthal S, Watts JA, Diaz-Buxo J. Large-pore hemodialysis in acute endotoxin shock. Critical Care Medicine. 1999;27(3):588-596.
Kline, Jeffrey ; Gordon, Brian E. ; Williams, Cliff ; Blumenthal, Susan ; Watts, John A. ; Diaz-Buxo, José. / Large-pore hemodialysis in acute endotoxin shock. In: Critical Care Medicine. 1999 ; Vol. 27, No. 3. pp. 588-596.
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