Abstract
The majority of patients with respiratory failure seen in our institution developed it as part of multiple organ failure complicated by other organ failures such as renal or hepatic failure. The alleviation of pulmonary interstitial edema has been one of the most important therapeutic approaches since pulmonary edema is considered to be the main cause of impaired pulmonary function in patients with nultiple organ failure.
However, the treatment of interstitial edema is difficult especially when it is associated with renal failure. We applied continuous hemofiltration (CHF) or continuous hemodiafiltrayion (CHDF) in the treatment of 59 patients with respiratory failure complicated by renal failure between January 1988 and March 1993. We studied the changes in the levels of FIO2 and PEEP needed to obtain acceptable PaO2 and cumulative water balance (CWB) levels following CHF/CHDF treatment for 3 consecutive days. The levels of FIO2 and PEEP decreased significantly as did the respiratory index following CHF/CHDF treatment, indicating an improvement in oxygenation. The average of CWB during the 3 days of the study period was 2282ml on negative balance. However, the CVP showed no significant changes, suggesting that CHF/CHDF can remove pulmonary interstitial edema without causing remarkable changes in the circulating blood volume. We conclude that CHF/CHDF is an effective method for reducing pulmonary edema in the treatment of the patients with simultaneous respiratory and renal failure.
