Abstract
Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
| Original language | English |
|---|---|
| Pages (from-to) | 832-837 |
| Number of pages | 6 |
| Journal | Annals of Thoracic Surgery |
| Volume | 71 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 24 Mar 2001 |
| Externally published | Yes |
Cite this
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Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. / Bent, Paul; Tan, Han Khim; Bellomo, Rinaldo; Buckmaster, Jonathan; Doolan, Laurie; Hart, Graeme; Silvester, William; Gutteridge, Geoffrey; Matalanis, George; Raman, Jai; Rosalion, Alexander; Buxton, Brian F.
In: Annals of Thoracic Surgery, Vol. 71, No. 3, 24.03.2001, p. 832-837.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery
AU - Bent, Paul
AU - Tan, Han Khim
AU - Bellomo, Rinaldo
AU - Buckmaster, Jonathan
AU - Doolan, Laurie
AU - Hart, Graeme
AU - Silvester, William
AU - Gutteridge, Geoffrey
AU - Matalanis, George
AU - Raman, Jai
AU - Rosalion, Alexander
AU - Buxton, Brian F.
PY - 2001/3/24
Y1 - 2001/3/24
N2 - Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
AB - Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
UR - http://www.scopus.com/inward/record.url?scp=0035101842&partnerID=8YFLogxK
U2 - 10.1016/S0003-4975(00)02177-9
DO - 10.1016/S0003-4975(00)02177-9
M3 - Article
C2 - 11269461
AN - SCOPUS:0035101842
VL - 71
SP - 832
EP - 837
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 3
ER -