Cargando…

Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study

Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopres...

Descripción completa

Detalles Bibliográficos
Autores principales: Nogi, Kazutaka, Shiraishi, Atsushi, Yamamoto, Ryohei, Sasano, Mikio, Matsumoto, Takashi, Karumai, Toshiyuki, Hayashi, Yoshiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063923/
https://www.ncbi.nlm.nih.gov/pubmed/32166246
http://dx.doi.org/10.1097/CCE.0000000000000065
_version_ 1783504782817755136
author Nogi, Kazutaka
Shiraishi, Atsushi
Yamamoto, Ryohei
Sasano, Mikio
Matsumoto, Takashi
Karumai, Toshiyuki
Hayashi, Yoshiro
author_facet Nogi, Kazutaka
Shiraishi, Atsushi
Yamamoto, Ryohei
Sasano, Mikio
Matsumoto, Takashi
Karumai, Toshiyuki
Hayashi, Yoshiro
author_sort Nogi, Kazutaka
collection PubMed
description Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopressor requirements before and after intermittent hemodialysis among patients who received intermittent hemodialysis to manage metabolic acidosis during resuscitation of septic shock. DESIGN: This retrospective, cross-sectional study was conducted between April 2014 and September 2015. SETTINGS: The ICU of a non-university-affiliated teaching hospital. PATIENTS: Patients who were admitted to the ICU with septic shock and underwent intermittent hemodialysis to manage metabolic acidosis within 48 hours after the diagnosis of septic shock. MEASUREMENTS AND MAIN RESULTS: The main outcomes were mean arterial pressure, minute ventilator volume, norepinephrine requirement, bicarbonate and pH before and after intermittent hemodialysis. Of 1,190 patients screened, 34 were included, and 33 accomplished a planned session of intermittent hemodialysis. After intermittent hemodialysis, an increased mean arterial pressure (+9.0 mm Hg; 95% CI, 6–13; p < 0.001), decreased minute ventilatory volume (–2.0 L/min; 95% CI, –3.3 to 0.8; p = 0.002), decreased norepinephrine requirement (–0.07 µg/kg/min; 95% CI, –0.12 to –0.02; p = 0.009), increased bicarbonate level (+7.2 mmol/L; 95% CI, 6.1–8.3; p < 0.001), and increased pH (+0.17; 95% CI, 0.13–0.21; p < 0.001) were observed in comparison to those before intermittent hemodialysis. CONCLUSIONS: In conclusion, intermittent hemodialysis appeared to be feasible and to stabilize hemodynamic and respiratory conditions in patients with septic shock complicated by metabolic acidosis during resuscitation.
format Online
Article
Text
id pubmed-7063923
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-70639232020-03-12 Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study Nogi, Kazutaka Shiraishi, Atsushi Yamamoto, Ryohei Sasano, Mikio Matsumoto, Takashi Karumai, Toshiyuki Hayashi, Yoshiro Crit Care Explor Observational/Cohort Study Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopressor requirements before and after intermittent hemodialysis among patients who received intermittent hemodialysis to manage metabolic acidosis during resuscitation of septic shock. DESIGN: This retrospective, cross-sectional study was conducted between April 2014 and September 2015. SETTINGS: The ICU of a non-university-affiliated teaching hospital. PATIENTS: Patients who were admitted to the ICU with septic shock and underwent intermittent hemodialysis to manage metabolic acidosis within 48 hours after the diagnosis of septic shock. MEASUREMENTS AND MAIN RESULTS: The main outcomes were mean arterial pressure, minute ventilator volume, norepinephrine requirement, bicarbonate and pH before and after intermittent hemodialysis. Of 1,190 patients screened, 34 were included, and 33 accomplished a planned session of intermittent hemodialysis. After intermittent hemodialysis, an increased mean arterial pressure (+9.0 mm Hg; 95% CI, 6–13; p < 0.001), decreased minute ventilatory volume (–2.0 L/min; 95% CI, –3.3 to 0.8; p = 0.002), decreased norepinephrine requirement (–0.07 µg/kg/min; 95% CI, –0.12 to –0.02; p = 0.009), increased bicarbonate level (+7.2 mmol/L; 95% CI, 6.1–8.3; p < 0.001), and increased pH (+0.17; 95% CI, 0.13–0.21; p < 0.001) were observed in comparison to those before intermittent hemodialysis. CONCLUSIONS: In conclusion, intermittent hemodialysis appeared to be feasible and to stabilize hemodynamic and respiratory conditions in patients with septic shock complicated by metabolic acidosis during resuscitation. Wolters Kluwer Health 2019-12-10 /pmc/articles/PMC7063923/ /pubmed/32166246 http://dx.doi.org/10.1097/CCE.0000000000000065 Text en Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational/Cohort Study
Nogi, Kazutaka
Shiraishi, Atsushi
Yamamoto, Ryohei
Sasano, Mikio
Matsumoto, Takashi
Karumai, Toshiyuki
Hayashi, Yoshiro
Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title_full Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title_fullStr Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title_full_unstemmed Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title_short Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
title_sort intermittent hemodialysis for managing metabolic acidosis during resuscitation of septic shock: a descriptive study
topic Observational/Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063923/
https://www.ncbi.nlm.nih.gov/pubmed/32166246
http://dx.doi.org/10.1097/CCE.0000000000000065
work_keys_str_mv AT nogikazutaka intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT shiraishiatsushi intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT yamamotoryohei intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT sasanomikio intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT matsumototakashi intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT karumaitoshiyuki intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy
AT hayashiyoshiro intermittenthemodialysisformanagingmetabolicacidosisduringresuscitationofsepticshockadescriptivestudy