التفاصيل البيبلوغرافية
| العنوان: |
Early High-Volume Hemofiltration versus Standard Care for Post-Cardiac Surgery Shock. The HEROICS Study. |
| المؤلفون: |
Combes, Alain, Bréchot, Nicolas, Amour, Julien, Cozic, Nathalie, Lebreton, Guillaume, Guidon, Catherine, Zogheib, Elie, Thiranos, Jean-Claude, Rigal, Jean-Christophe, Bastien, Olivier, Benhaoua, Hamina, Abry, Bernard, Ouattara, Alexandre, Trouillet, Jean-Louis, Mallet, Alain, Chastre, Jean, Leprince, Pascal, Luyt, Charles-Edouard |
| المصدر: |
American Journal of Respiratory & Critical Care Medicine; 11/15/2015, Vol. 192 Issue 10, p1179-1190, 21p, 2 Diagrams, 6 Charts, 6 Graphs |
| مصطلحات موضوعية: |
KIDNEY disease statistics, BLOOD filtration, CATECHOLAMINES, COMPARATIVE studies, CAUSES of death, CARDIAC surgery, KIDNEY diseases, LONGITUDINAL method, RESEARCH methodology, EVALUATION of medical care, MEDICAL quality control, MEDICAL cooperation, RESEARCH, SHOCK (Pathology), THERAPEUTICS, EVALUATION research, RANDOMIZED controlled trials, PROPORTIONAL hazards models, HOSPITAL mortality, PREVENTION |
| مصطلحات جغرافية: |
FRANCE |
| مستخلص: |
Rationale: Post-cardiac surgery shock is associated with high morbidity and mortality. By removing toxins and proinflammatory mediators and correcting metabolic acidosis, high-volume hemofiltration (HVHF) might halt the vicious circle leading to death by improving myocardial performance and reducing vasopressor dependence.Objectives: To determine whether early HVHF decreases all-cause mortality 30 days after randomization.Methods: This prospective, multicenter randomized controlled trial included patients with severe shock requiring high-dose catecholamines 3-24 hours post-cardiac surgery who were randomized to early HVHF (80 ml/kg/h for 48 h), followed by standard-volume continuous venovenous hemodiafiltration (CVVHDF) until resolution of shock and recovery of renal function, or conservative standard care, with delayed CVVHDF only for persistent, severe acute kidney injury.Measurements and Main Results: On Day 30, 40 of 112 (36%) HVHF and 40 of 112 (36%) control subjects (odds ratio, 1.00; 95% confidence interval, 0.64-1.56; P = 1.00) had died; only 57% of the control subjects had received renal-replacement therapy. Between-group survivors' Day-60, Day-90, intensive care unit, and in-hospital mortality rates, Day-30 ventilator-free days, and renal function recovery were comparable. HVHF patients experienced faster correction of metabolic acidosis and tended to be more rapidly weaned off catecholamines but had more frequent hypophosphatemia, metabolic alkalosis, and thrombocytopenia.Conclusions: For patients with post-cardiac surgery shock requiring high-dose catecholamines, the early HVHF onset for 48 hours, followed by standard volume until resolution of shock and recovery of renal function, did not lower Day-30 mortality and did not impact other important patient-centered outcomes compared with a conservative strategy with delayed CVVHDF initiation only for patients with persistent, severe acute kidney injury. Clinical trial registered with www.clinicaltrials.gov (NCT 01077349). [ABSTRACT FROM AUTHOR] |
|
Copyright of American Journal of Respiratory & Critical Care Medicine is the property of American Thoracic Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder