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Intensive Care Med. 1999 Aug;25(8):814-21.

Outcome of critically ill patients treated with intermittent high-volume haemofiltration: a prospective cohort analysis.

Author information

1
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P. O. Box 95500, 1090 HM Amsterdam, The Netherlands. h.m.oudemans-vanstraaten@olvg.nl

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.

PMID:
10447538
[Indexed for MEDLINE]

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