Early venovenous haemodiafiltration for sepsis-related multiple organ failure.docVIP

Available online /content/10/2/409 Letter Early venovenous haemodiafiltration for sepsis-related multiple organ failure Frédéric M Jacobs and Fran?ois G Brivet Service de Réanimation Médiacle, H?pital Antoine Béclère-Assistance, Publique H?pitaux de Paris, Paris, France Corresponding author: Frédéric M Jacobs, frederic.jacobs@abc.aphp.fr Published: 27 April 2006 Critical Care 2006, 10:409 (doi:10.1186/cc4906) This article is online at /content/10/2/409 ? 2006 BioMed Central Ltd See related research by Page et al., /content/9/6/R755 In a prospective observational study that included 60 is widely accepted that early lactate clearance is associated with improved outcomes in septic shock [2] and that lactate levels are not affected by CVVHDF [3]. In the study by Page and coworkers [1] one cannot exclude the possibility that the lack of improvement in base excess in the nonresponder group was linked to persistent lactate production, and so consecutive patients over a 10-year period, Page and coworkers [1] studied the effects of early continuous veno- venous haemodiafiltration (CVVHDF) during sepsis-induced multiple organ failure. In two-thirds of the patients rapid metabolic improvement during CVVHDF was associated with circulatory improvement and a low mortality rate, whereas lack of metabolic improvement after 12 hours of CVVHDF (mainly based on changes in base excess) was associated with a 100% mortality rate. The authors concluded that early CVVHDF may improve the prognosis of sepsis-related multiple organ failure, and that failure to correct metabolic acidosis rapidly during the procedure is a strong predictor of mortality. metabolic improvement during the procedure is not necessarily superior to the trend in blood lactate as a predictive tool. Although beneficial effects of early high-volume isovolaemic haemofiltration ha