If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Large-Volume Mechanical Fluid Removal Improves Renal Function in Patients With Refractory Decompensated Heart Failure: Presented at HF2008 By Chris Berrie MILAN, Italy -- June 19, 2008 -- Large-volume mechanical fluid removal resolves elevated intra-abdominal pressure (IAP) in volume-overloaded patients with advanced decompensated heart failure (ADHF) and promptly improves renal function in the absence of direct haemodynamic compromise. Principal investigator Wilfried Mullins, MD, Heart Failure and Transplantation Department, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, presented the findings from a prospective study here on June 16 at the Heart Failure 2008 (HF2008) Congress. As abdominal girth increases, a critical volume is reached where compliance of the abdominal wall decreases abruptly, which is followed by a rapid rise in IAP (to 8 mm Hg or greater) and resultant organ dysfunction. Dr. Mullens and colleagues recently reported that elevated IAP can be associated with renal dysfunction in patients with advanced decompensated heart failure, and hypothesised that mechanical fluid removal in these patients could provide improvements in IAP and renal function. For their new study, the researchers enrolled 9 patients 18 years or older with ADHF and New York Heart Association functional class III/IV who were refractory to intensive medical therapy with right heart catheterisation. They had worsening systolic chronic heart failure defined as a left ventricular ejection fraction (LVEF) <30%, and pulmonary capillary wedge pressure >18 mm Hg refractory to IV diuretics. Mechanical fluid removal for clinically apparent abdominal ascites or overt excessive fluid was performed by paracentesis in 5 patients (>1,000 mL/30 min) and by ultrafiltration in 4 patients (100-200 mL/h; >12 h). The main exclusion criteria were artificial ventilation, abdominal/thoracic surgery in previous 3 months, dialysis, or no Foley catheter. Transvesical IAP was measured with the patient supine, 18-gauge needle with pressure transducer inserted in aspiration port of Foley catheter, clamp drainage tube, instillation of saline (25-30 mL) for fluid-filled column to bladder, pressure transducer at mid-axillary line, and IAP measured at end expiration without abdominal contractions. Baseline clinical characteristics were mean age of 67 years, 67% male, and idiopathic dilated/ischaemic heart failure (77%/23%), with a mean LVEF of 18%. On admission, their current heart failure medication was modified to intensive medical therapy. Patients' haemodynamic characteristics at the start of mechanical fluid removal were a systemic blood pressure of 110 mm Hg, central venous pressure of 19 mm Hg, pulmonary capillary wedge pressure of 22 mm Hg, cardiac index of 2.4 L/min/m2, creatinine of 3.4 mg/dL, and IAP of 13 mm Hg. Mean mechanical fluid removal was 3,187 mL by paracentesis and 1,800 mL by ultrafiltration. Similar benefits were seen in the 2 treatment groups, with significant reduction in IAP from 13 to 7 mm Hg (P = .001) and a corresponding improvement in renal function (serum creatinine from 3.4 to 2.4 mg/dL; P = .01). Dr. Mullens summarised, "In volume overload with patients who are admitted with acute decompensated heart failure refractory to intensive medical therapy, we observed a reduction of otherwise persistently elevated intra-abdominal pressure, with corresponding improvement in renal function following this fluid removal."
[Presentation title: Prompt Reduction in Intra-Abdominal Pressure Following Large-Volume Mechanical Fluid Removal Improves Renal Insufficiency in Refractory Decompensated Heart Failure. Abstract P557]
|
