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      Hemodynamic Response to Fluid Withdrawal in Overhydrated Patients Treated with Intermittent Ultrafiltration and Slow Continuous Ultrafiltration: Role of Blood Volume Monitoring

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          Abstract

          Fluid overload may occur in patients with congestive heart failure, especially when there is associated acute renal failure. When the pharmacological approach is not sufficient to maintain the patient’s fluid balance, extracorporeal therapies must be instituted. However, since the ultrafiltration rate may be faster than fluid refilling from the interstitial space, remarkable changes in the circulating blood volume may occur. This may finally result in further worsening of peripheral perfusion due to a significant drop in cardiac output. In order to prevent a fall in the circulating blood volume, slow continuous ultrafiltration (SCUF) should be employed instead of acute intermittent ultrafiltration (UF). To further improve the tolerance to extracorporeal ultrafiltration, the session can be driven by the relative blood volume change monitored on-line with adequate sensors and devices. We utilized one of these systems (Crit-Line, Hemametrics, USA) to compare the relative changes in blood volume during UF and SCUF in 22 patients with fluid overload. Variations in blood pressure were significantly greater with UF than with SCUF even in the presence of similar levels of fluid removal. The variations in blood pressure were paralleled by variations in blood volume, which were greater with UF than with SCUF. In conclusion, extracorporeal ultrafiltration can be used to control the fluid balance in congestive heart failure, but it is advisable to prescribe low ultrafiltration rates over an extended period of time. The use of on-line blood volume monitors can be of further help in improving tolerance and the hemodynamic response.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-7380-1
          978-3-318-00820-3
          0008-6312
          1421-9751
          2001
          2001
          18 January 2002
          : 96
          : 3-4
          : 196-201
          Affiliations
          aDepartment of Nephrology, St. Bortolo Hospital, Vicenza, Italy, bIntensive Care Unit, Austin and Repatriation Medical Center, Heidelberg, Vic., Australia
          Article
          47404 Cardiology 2001;96:196–201
          10.1159/000047404
          11805387
          © 2002 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 6, References: 22, Pages: 6
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