Continuous Veno-venous Hemofiltration to Adjust Fluid Volume Excess in Septic Shock Patients Reduces Intra-abdominal Pressure

Objective: To analyze the effect and the time course of continuous veno-venous hemofiltration (CVVH) with net ultrafiltration (UF) on intra-abdominal pressure (IAP) body fluid volumes in septic shock patients with acute kidney injury (AKI).

Methods: Patients were studied at baseline and after 6, 12, 24, 48, 72, and 96 hours of CVVH treatment. IAP was measured via the bladder, and abdominal perfusion pressure (APP) was calculated as mean arterial pressure minus IAP. Fluid volume excess (VE), total body water (TBW), extracellular body water (ECW), and intracellular body water (ICW) were derived from wholebody bioimpedance analysis (BIA).

Results: 30 patients entered final analysis, of which 6 died during CVVH (non-survivors). Fluid VE, TBW, ECW, ICW, and IAP significantly decreased in 24 survivors, whereas these variables remained essentially unchangedin non-survivors. APP slowly increased in survivors, while it did not change in nonsurvivors. IAP strongly correlated with VEin survivors: The lower the IAP, the lower the fluid volume excess.

Conclusion: CVVH with net UF successfully reduced IAP, TBW, ECW, and ICW in critically ill patients who survived 96 h of CVVH. Failure to increase APP was associated with fatal outcome, and, finally, IAP correlated with fluid volume excess. BIA could be helpful to monitor fluid status in patients with AKI.