American journal of kidney diseases : the official journal of the National Kidney Foundation
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Randomized Controlled Trial Clinical Trial
Cytokines clearance during venovenous hemofiltration in the trauma patient.
The objective of the study was to investigate whether continuous venovenous hemofiltration (CVVH) would facilitate removal of substantial amounts of tumor necrosis factor (TNF) and interleukin-6 (IL-6) from the circulation in traumatized critically ill patients with multiple organ dysfunction syndrome. The study design was a prospective, nonblind, randomized controlled trial that was set in the trauma intensive care unit of a tertiary university referral hospital. Thirty consecutive critically ill, mechanically ventilated trauma patients with multiple organ dysfunction syndrome (without renal failure) were included in the study. ⋯ Similar results were found with IL-6 concentration that decreased from the pretreatment level to a mean of 554+/-731 pg/mL in patients and 382 +/-568 pg/mL in control subjects. In conclusion, CVVH is associated with removal of substantial amounts of TNF and IL-6 from the circulation in traumatized critically ill patients, but the profile of these mediators is similar to that of controls, suggesting a nonclinically relevant elimination. Further prospective, randomized, clinical trials are needed to support our results.
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Case Reports
Marked dilutional acidosis complicating management of right ventricular myocardial infarction.
Dilutional acidosis is a poorly recognized cause of metabolic acidosis. Indeed, the prevailing view has been that even massive expansion of the extracellular fluid volume with non-bicarbonate-containing solutions would not lead to clinically significant hypobicarbonatemia. We describe the development of marked dilutional acidosis as a complication of management of right ventricular myocardial infarction. The pathogenesis, clinical significance, prevention, and treatment of the entity are discussed.
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The utility of measurement of the inferior vena cava diameter (IVCD) with ultrasound for the assessment of fluid status and posthemodialysis dry weight was studied in 35 hemodialysis (HD) patients, 17 with and 18 without hypertension. In 17 patients (group A), IVCD was measured before and 35 to 40 minutes after HD, pre-HD blood volume (BV) was measured with radiolabeled albumin and post-HD BV was calculated from the change in hematocrit. In 18 patients (group B), IVCD was measured repeatedly during HD and 2 hours after HD. ⋯ In 8 patients studied twice, IVCD increased much more after a 3-hour HD session than after a 6-hour session. At the end of HD, several patients had IVCD below the reference range but IVCD increased during the following 1 to 2 hours, in some patients to values above the reference range. IVCD measured at the end or shortly after HD may therefore be misleading in assessing dry weight.