Published online Sep 15, 2003. doi: 10.3748/wjg.v9.i9.2096
Revised: April 2, 2003
Accepted: April 11, 2003
Published online: September 15, 2003
AIM: To investigate the efficiency of continuous high volume hemofiltration (HVHF) in the treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).
METHODS: A total of 28 SAP patients with an average of 14.36 ± 3.96 APACHE II score were involved. Diagnostic criteria for SAP standardized by the Chinese Medical Association and diagnostic criteria for MODS standardized by American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM) were applied for inclusion. HVHF was started 6.0 ± 6.1 (1-30) days after onset of the disease and sustained for at least 72 h, AN69 hemofilter (1.2 m2) was changed every 24 h. The ultrafiltration rate during HVHF was 4000 mL/h, blood flow rate was 250-300 mL/min, and the substitute fluid was infused with pre-dilution. Low molecular weight heparin was used for anticoagulation.
RESULTS: HVHF was well tolerated in all the patients, and lasted for 4.04 ± 3.99 (3-24) days. 20 of the patients survived, 6 patients died and 2 of the patients quited for financial reason. The ICU mortality was 21.4%. Body temperature, heart rate and breath rate decreased significantly after HVHF. APACHE II score was 14.4 ± 3.9 before HVHF, and 9.9 ± 4.3 after HVHF, which decreased significantly (P < 0.01). Partial pressure of oxygen in arterial blood before HVHF was 68.5 ± 19.5 mmHg, and increased significantly after HVHF, which was 91.9 ± 25 mmHg (P < 0.01). During HVHF the hemodynamics was stable, and serum potassium, sodium, chlorine, glucose and pH were at normal level.
CONCLUSION: HVHF is technically possible in SAP patients complicated with MODS. It does not appear to have detrimental effects and may have beneficial effects. Continuous HVHF, which seldom disturbs the hemodynamics and causes few side-effects, is expected to become a beneficial adjunct therapy for SAP complicated with MODS.