Outcome of critically ill patients treated with intermittent high-volume haemofiltration: a prospective cohort analysis |
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Authors: | H M Oudemans-van Straaten R J Bosman J I van der Spoel D F Zandstra |
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Institution: | (1) Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P. O. Box 95500, 1090 HM Amsterdam, The Netherlands e-mail: h.m.oudemans-vanstraaten @olvg.nl; Tel. + 31(20)5 99 30 07 Fax + 31(20)5 99 21 28, NL |
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Abstract: | Objective: To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF). Design: Prospective cohort analysis. Setting: 18-bed closed format general intensive care unit (ICU) of a teaching hospital. Patients: 30-month cohort of ICU patients treated with HV-HF. Interventions: Intermittent high-volume venovenous haemofiltration. Endpoints: Observed and predicted mortality in prospectively stratified prognostic groups. Measurements and results: Clinical and filtration data, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score
(SAPS) II and the Madrid Acute Renal Failure (ARF) score and predicted mortality. A total of 306 patients were haemofiltrated
(140 medical, 166 surgical), 52 % were oliguric. Mean APACHE II score was 31 (SD 8) and mean SAPS II score 60 (SD 16). Mean
ultrafiltrate rate was 63 ml/min (SD 20). A median total of 160 litres (90 % range 49 to 453) were filtrated per patient,
material costs were 565 ECU (90 % range 199 to 1514). ICU mortality was 33 %, hospital mortality 40 % 95 % confidence interval
(CI) 34 to 45], predicted mortality by the ARF score 67 % (CI 66 to 69). Non-cardiac surgery mortality was 47 % (CI 39 to
54), 73 % (CI 70 to 76) predicted by APACHE II and 67 % (CI 64 to 70) by SAPS II. Observed mortality was significantly lower
than predicted in all prognostic groups. The standardised mortality ratio (SMR) was no higher than the SMR in the overall
ICU population. Conclusions: Mortality in HV-HF patients was lower than that predicted by illness severity scores, as was the case in all patients in
our ICU. Treatment with HV-HF appears to be safe and feasible. The efficacy of HV-HF should be tested in randomised, controlled
trials of suitable power.
Received: 4 December 1998 Final revision received: 20 April 1999 Accepted: 17 May 1999 |
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Keywords: | Haemofiltration Acute renal failure Multiple organ failure Severity of illness Hospital mortality Outcome prediction |
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