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Khirurgii

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Year 2017 Vol. 25 No 2

ANESTESIOLOGY-REANIMATOLOGY

R.E. YAKUBTSEVICH

OPTIMIZATION OF HAEMODYNAMICS AND HYDROBALANCE WITH TRANSPULMONAL THERMODILUTION WHILE APPLYING CONTINUOUS METHODS OF RENAL REPLACEMENT THERAPY IN PATIENTS WITH SEVERE SEPSIS AND MULTIPLE ORGAN DYSFUNCTION

EE "Grodno State Medical University",
Grodno
The Republic of Belarus

Objectives. To evaluate the effectiveness of PiCCO monitoring parameters for making a decision on the regulation of hydrobalance and correction of hemodynamics during the continuous veno-venous haemofiltration (CVVHF) or haemodiafiltration (CVVHDF) in severe sepsis with multiple organ dysfunction.
Methods. 36 sessions of renal replacement therapy (RRT) (14 – CVVHF and 22 – CVVHDF) in 18 patients with sepsis resulting in multiple organ dysfunction syndrome have been analyzed. Hemodynamic parameters and hydrobalance was measured in 15 cases using the invasive PiCCO monitor during the CVVHDF procedure every 4-6 hours. In 21 cases the assessment of hemodynamics and hydrobalance was carried out by the non-invasive measurement of the mean arterial pressure (MAP) and central venous pressure (CVP).
Results. It was found out that the critical period of haemodynamics during the sessions of RRT was every 4-6 hour from the beginning of the procedure. Within this period a significant reduction of MAP was observed. Critical changes of MAP in patients monitored by the PiCCO were not recorded. There were no significant changes in the cardiac index despite the ultrafiltration and the positive dynamics manifested by reduction of global end-diastolic volume index (GEDI) and the extravascular lung water index (ELWI) just 6 hours from the session onset. This stability was due to the early physicians response to the change of PiCCO parameters, without waiting for the systematic blood pressure reduction in an adequate dose correction of inotropic support and regulation of the ultrafiltration rate in its reducing or complete stopping, as well as by the prescription of vasopressor support.
Conclusion. PiCCO monitoring turned out to be effective for making a decision on the regulation and correction of hemodynamics and hydrobalance during CVVHF or CVVHDF in severe sepsis with multiple organ dysfunction syndrome.

Keywords: continuous methods of renal replacement therapy, continuous veno-venous haemofiltration, continuous veno-venous haemodiafiltration, transpulmonary thermodilution, PiCCO, severe sepsis, multiple organ dysfunction syndrome
p. 171-176 of the original issue
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Address for correspondence:
230000, Republic of Belarus,
Grodno, Gorky str., 80, EE "Grodno
State Medical University", Department
of anesthesiology and intensive care.
Tel.: 375 152 43-40-85
E-mail: jackruslan@tut.by
Ruslan E. Yakubtsevich
Information about the authors:
Yakubtsevich R.E. PhD, Ass. Professor of the department of anesthesiology and critical care medicine, EE "Grodno State Medical University".
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