Large-pore hemodialysis in acute endotoxin shock

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

Research output: Contribution to journalArticle

24 Scopus citations

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
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

Keywords

  • Endotoxin shock
  • Hemodialysis
  • Hemofiltration
  • Ventricular contractility

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Kline, J. A., 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. https://doi.org/10.1097/00003246-199903000-00041