High-Volume Hemofiltration as Adjuvant Therapy for Refractory Shock after Pericardiocentesis

2011 ◽  
Vol 14 (5) ◽  
pp. 313
Author(s):  
Romuald Lango ◽  
Maciej M. Kowalik ◽  
Piotr Siondalski ◽  
Jan Rogowski ◽  
Alicja Dabrowska-Kugacka
Keyword(s):  
Cardiac Tamponade ◽  
Inflammatory Mediators ◽  
Experimental Studies ◽  
High Volume ◽  
Left Ventricular ◽  
Sudden Increase ◽  
Refractory Shock ◽  
Hemodynamic Deterioration ◽  
High Volume Hemofiltration ◽  
Hemodynamic Improvement

<p><b>Background:</b> Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.</p><p><b>Case Report:</b> We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.</p><p><b>Discussion:</b> The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.</p><p><b>Conclusions:</b> We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.</p>

Subarachnoid Hemorrhage and Extracorporeal Blood Purification with HA-380 and High-Volume Hemofiltration: A New Therapeutic Challenge at the Neurocritical Care Unit? A Case Report

2021 ◽  
pp. 1-4
Author(s):  
Gonzalo Ramírez-Guerrero ◽  
Rocio Oliva Alarcón ◽  
Francisco Villagrán Cortés ◽  
Vicente Torres Cifuentes ◽  
Romyna Baghetti Hernández ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurocritical Care ◽  
High Volume ◽  
Refractory Shock ◽  
Source Of Infection ◽  
Extracorporeal Blood Purification ◽  
Hemodynamic Deterioration ◽  
Management Of Complications ◽  
High Volume Hemofiltration ◽  
High Doses

We present the case of a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured cerebral aneurysm and a refractory shock with high doses of vasopressors without a proven source of infection. This patient received therapy with high-volume hemofiltration plus adsorption, resolving the hemodynamic deterioration and with good neurological evolution. Our clinical case proposes that extracorporeal therapies may have a feasibility role in the management of complications of SAH.

scholarly journals Early Fluid Resuscitation and High Volume Hemofiltration Decrease Septic Shock Progression in Swine

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ping Zhao ◽  
Ruiqiang Zheng ◽  
Lu Xue ◽  
Min Zhang ◽  
Xiaoyan Wu
Keyword(s):  
Septic Shock ◽  
Fluid Intake ◽  
High Volume ◽  
Left Ventricular ◽  
Swine Model ◽  
Ventricular Contractility ◽  
Vasoactive Drugs ◽  
High Volume Hemofiltration ◽  
Early Fluid ◽  
Partial Oxygen

This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control(n=6)(extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n=6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n=6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h). Hemodynamic parameters (arterial pressure, heart rate, cardiac output, stroke volume variability, left ventricular contractility, systemic vascular resistance, and central venous pressure), vasoactive drug parameters (dose and time of norepinephrine and hourly fluid intake), pulmonary function (partial oxygen pressure and vascular permeability), and cytokines (interleukin-6 and interleukin-10) were observed. Treatment resulted in significant changes at 4–6 h. HVHF was beneficial, as shown by the dose of vasoactive drugs, fluid intake volume, left ventricular contractility index, and partial oxygen pressure. Both CRRT and HVHF groups showed improved removal of inflammatory mediators compared with controls. In conclusion, EFR combined with HVHF improved septic shock in this swine model. The combination decreased shock progression, reduced the need for vasoactive drugs, and alleviated the damage to cardiopulmonary functions.

scholarly journals The incidence of myopericarditis in patients with COVID-19

2021 ◽  
Vol 13 (3) ◽  
pp. 203-207
Author(s):  
Atoosa Mostafavi ◽  
Seyed Abdol Hussein Tabatabaei ◽  
Somayeh Zamani Fard ◽  
Fatemeh Majidi ◽  
Abbas Mohagheghi ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Definite Diagnosis ◽  
Pleuritic Chest Pain ◽  
Qt Interval Prolongation ◽  
Organ Systems ◽  
Hemodynamic Deterioration

Introduction: SARS-COV-2 can affect different organ systems, including the cardiovascular system with wide spectrum of clinical presentations including the thrombotic complications, acute cardiovascular injury and myopericarditis. There is limited study regarding COVID-19 and myopericarditis. The aim of this study was to evaluate myopericarditis in patients with definite diagnosis of COVID-19. Methods: In this observational study we analyzed the admitted patients with definite diagnosis of COVID-19 based on positive RT-PCR test. Laboratory data, and ECG changes on days 1-3-5 were analyzed for sign of pericarditis and also QT interval prolongation. Echocardiography was performed on days 2-4 and repeated as necessary, and one month after discharge for possible late presentation of symptom. Any patient with pleuritic chest pain, and pericardial effusion and some rise in cardiac troponin were considered as myopericarditis. Results: A total of 404 patients (18-90 years old, median =63, 273 males and 131 females) with definite diagnosis of COVID-19 were enrolled in the study. Five patients developed in-hospital pleuritic chest pain with mild left ventricular dysfunction and mild pericardial effusion and diagnosed as myopericarditis, none of them proceed to cardiac tamponade. We found no case of late myopericarditis. Conclusion: Myopericarditis, pericardial effusion and cardiac tamponade are rare complication of COVID-19 with prevalence about 1.2 %, but should be considered as a possible cause of hemodynamic deterioration.

High-Volume Hemofiltration as Rescue Therapy for Refractory Shock After Inadvertent Rapid Aprotinin Administration

2009 ◽  
Vol 23 (4) ◽  
pp. 526-528 ◽  
Author(s):  
Romuald Lango ◽  
Maciej Michał Kowalik ◽  
Katarzyna Klajbor ◽  
Rafał Pawlaczyk ◽  
Violetta Musiał-Świątkiewicz ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
High Volume ◽  
Refractory Shock ◽  
High Volume Hemofiltration

Plasma Filtration Adsorption Dialysis (PFAD): A New Technology for Blood Purification

2005 ◽  
Vol 28 (7) ◽  
pp. 731-738 ◽  
Author(s):  
F. Nalesso
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Severe Sepsis ◽  
Inflammatory Mediators ◽  
High Volume ◽  
Blood Purification ◽  
Plasma Filtration ◽  
High Volume Hemofiltration ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

Severe sepsis is one of the most significant challenges in critical care. Despite all the developments achieved in infectious diseases and critical care, along with numerous attempts to develop treatments, the mortality rate of severe sepsis and septic shock remains unacceptably high. The pathophysiology of severe sepsis and septic shock is only partially understood. Circulating pro-inflammatory and anti-inflammatory mediators appear to participate in the complex cascade of events which leads to deranged microcirculatory function, as we know from the peak concentration hypothesis. Therapeutic trials targeting single pro-inflammatory and anti-inflammatory mediators failed to demonstrate any benefit, suggesting that the unselective removal of different mediators may be a more appropriate approach. In severe sepsis several blood purification techniques, such as continuous hemofiltration (CVVH), high volume hemofiltration (HVHF), pulse high volume hemofiltration (HVHF), plasma filtration, plasma adsorption, coupled plasma filtration adsorption (CPFA), have been proposed but such techniques appear to have both theorical as well as practical limitations. Plasma Filtration Adsorption Dialysis (PFAD) is a new extracorporeal treatment which combines different principles of blood purification in a single device. The core of this technique is a new dialyzer composed by three suitable compartments that provide specific functions. The association of multiple principles permits specific removal of molecules implicated in the pathophysiology of patient's disease and re-establishment of hydro-electrolyte, acid-base equilibrium, if renal dysfunction-failure is present. The final target of PFAD is to obtain complete purification by combining principles of physics and chemistry to remove hydrophilic and hydrophobic molecules with a very wide range of weights.

scholarly journals Early Cytokine Removal in Critical COVID-19 Patients with Extracorporeal Therapies (HA-380 plus High Volume Hemofiltration) May Prevent Progression of Acute Respiratory Distress Syndrome: Case Report

2020 ◽  
pp. 1-3
Author(s):  
Gonzalo Ramírez-Guerrero ◽  
Vicente Torres Cifuentes ◽  
Romyna Baghetti Hernández ◽  
Francisco Villagrán Cortés ◽  
Simón Rojas Doll ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Case ◽  
Distress Syndrome ◽  
High Volume ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Hemodynamic Deterioration ◽  
High Volume Hemofiltration

We present the case of a patient who suffered from acute respiratory distress syndrome caused by pneumonia associated with COVID-19 and cytokine release syndrome. This patient received a high-volume hemofiltration plus adsorption, solving the hemodynamic deterioration, pulmonary infiltrates, and gas exchange. Our clinical case proposes that the extracorporeal therapies can have a role in the management of severe COVID-19.

Cardiac tamponade from anticoagulant-related spontaneous haemopericardium in a patient with ischaemic cardiomyopathy and heart failure

2020 ◽  
Vol 13 (12) ◽  
pp. e238047
Author(s):  
Alicia Lefas ◽  
Neil Bodagh ◽  
Jiliu Pan ◽  
Ali Vazir
Keyword(s):  
Heart Failure ◽  
Cardiac Tamponade ◽  
Ventricular Dysfunction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Heart Failure Therapy ◽  
Severe Left Ventricular Dysfunction ◽  
Ischaemic Cardiomyopathy ◽  
Common Causes

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.

scholarly journals Computational Investigation of Transmural Differences in Left Ventricular Contractility

2016 ◽  
Vol 138 (11) ◽  
Author(s):  
Hua Wang ◽  
Xiaoyan Zhang ◽  
Shauna M. Dorsey ◽  
Jeremy R. McGarvey ◽  
Kenneth S. Campbell ◽  
...  
Keyword(s):  
Myocardial Contractility ◽  
Ex Vivo ◽  
Experimental Studies ◽  
Contractile Force ◽  
Left Ventricular ◽  
Lv Function ◽  
Fe Model ◽  
Myocardial Layers ◽  
Best Fit

Myocardial contractility of the left ventricle (LV) plays an essential role in maintaining normal pump function. A recent ex vivo experimental study showed that cardiomyocyte force generation varies across the three myocardial layers of the LV wall. However, the in vivo distribution of myocardial contractile force is still unclear. The current study was designed to investigate the in vivo transmural distribution of myocardial contractility using a noninvasive computational approach. For this purpose, four cases with different transmural distributions of maximum isometric tension (Tmax) and/or reference sarcomere length (lR) were tested with animal-specific finite element (FE) models, in combination with magnetic resonance imaging (MRI), pressure catheterization, and numerical optimization. Results of the current study showed that the best fit with in vivo MRI-derived deformation was obtained when Tmax assumed different values in the subendocardium, midmyocardium, and subepicardium with transmurally varying lR. These results are consistent with recent ex vivo experimental studies, which showed that the midmyocardium produces more contractile force than the other transmural layers. The systolic strain calculated from the best-fit FE model was in good agreement with MRI data. Therefore, the proposed noninvasive approach has the capability to predict the transmural distribution of myocardial contractility. Moreover, FE models with a nonuniform distribution of myocardial contractility could provide a better representation of LV function and be used to investigate the effects of transmural changes due to heart disease.

scholarly journals High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest

2005 ◽  
Vol 46 (3) ◽  
pp. 432-437 ◽  
Author(s):  
Ivan Laurent ◽  
Christophe Adrie ◽  
Christophe Vinsonneau ◽  
Alain Cariou ◽  
Jean-Daniel Chiche ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Volume ◽  
High Volume Hemofiltration ◽  
Hospital Cardiac Arrest
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