PMID- 7846371
OWN - NLM
STAT- MEDLINE
DCOM- 19950309
LR  - 20190909
IS  - 0300-9572 (Print)
IS  - 0300-9572 (Linking)
VI  - 28
IP  - 2
DP  - 1994 Oct
TI  - Combined acute respiratory and renal failure: management by continuous 
      hemodiafiltration.
PG  - 123-31
AB  - OBJECTIVES: To study the impact of continuous hemodiafiltration (CHD) on the 
      morbidity and mortality of acute combined respiratory and renal failure in 
      critically ill patients. DESIGN: Prospective clinical study. SETTING: Intensive 
      Care Unit of a tertiary institution. PATIENTS: One-hundred fifteen critically ill 
      patients with combined acute respiratory and renal failure. INTERVENTIONS: 
      Treatment of all patients with either continuous arteriovenous hemodiafiltration 
      (CAVHD) or continuous venovenous hemodiafiltration (CVVHD). MEASUREMENTS: 
      Assessment of illness severity, measurement of plasma urea, serum creatinine, 
      electrolytes and arterial blood gases prior to and during treatment. Duration of 
      oliguria, ICU stay, hospital stay, and final outcome. RESULTS: One hundred 
      fifteen critically ill patients with combined respiratory and renal failure (mean 
      APACHE II score, 28.1; mean number of failing organs, 4.1) were studied. 
      Thirty-five were treated with CAVHD and 80 with CVVHD for a mean treatment 
      duration of 13.1 days per patient (range 2-47). Blood urea concentration fell 
      from a mean of 29.4 mmol/l to a mean of 19.1 mmol/l (P < 0.001) and the serum 
      creatinine concentration fell from a mean of 520 mumol/l to a mean of 374 mumol/l 
      after 24 h of therapy (P < 0.001). The A-a gradient fell from a mean of 301 mmHg 
      to a mean of 242 mmHg (P < 0.05). Despite the high degree of illness severity and 
      the need for vasoactive drug infusion in 105 patients (91.3%), survival to 
      hospital discharge was achieved in 33 patients (28.7%). For patients who required 
      > 72 h of combined mechanical ventilation, survival was 22% (22 of 100 patients). 
      Complications of continuous hemodiafiltration were few and all related to 
      arterial vascular access. CONCLUSIONS: In critically ill patients with combined 
      acute respiratory and renal failure, continuous hemodiafiltration controlled 
      azotemia without hypotension and with early improvement in gas exchange. PATIENTS 
      treated with this approach achieved promising survival rates. Our findings 
      support the view that CHD is safe and effective and that it offers important 
      advantages over intermittent hemodialysis. It may be the dialytic therapy of 
      choice in critically ill patients with combined acute respiratory and renal 
      failure.
FAU - Bellomo, R
AU  - Bellomo R
AD  - Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
FAU - Farmer, M
AU  - Farmer M
FAU - Boyce, N
AU  - Boyce N
LA  - eng
PT  - Journal Article
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
RN  - 8W8T17847W (Urea)
SB  - IM
MH  - Acute Kidney Injury/blood/mortality/*therapy
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Hemodiafiltration/*methods
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Multiple Organ Failure/blood/mortality/*therapy
MH  - Prospective Studies
MH  - Respiratory Insufficiency/blood/mortality/*therapy
MH  - Survival Rate
MH  - Urea/pharmacokinetics
EDAT- 1994/10/01 00:00
MHDA- 1994/10/01 00:01
CRDT- 1994/10/01 00:00
PHST- 1994/10/01 00:00 [pubmed]
PHST- 1994/10/01 00:01 [medline]
PHST- 1994/10/01 00:00 [entrez]
AID - 0300-9572(94)90084-1 [pii]
AID - 10.1016/0300-9572(94)90084-1 [doi]
PST - ppublish
SO  - Resuscitation. 1994 Oct;28(2):123-31. doi: 10.1016/0300-9572(94)90084-1.