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CLINICAL STUDY

Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure

^a Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology, University of Milan, Milan, Italy

Manuscript received January 30, 2001; revised manuscript received May 21, 2001, accepted June 14, 2001.

Reprint requests and correspondence: Dr. GianCarlo Marenzi, Centro Cardiologico Monzino, via Parea 4, 20138 Milan, Italy
giancarlo.marenzi{at}cardiologicomonzino.it

OBJECTIVES

The goal of this study was to investigate the hemodynamic and circulatory adjustments to extracorporeal ultrafiltration (UF) in refractory congestive heart failure (rCHF).

BACKGROUND

In rCHF, UF allows clinical improvement and restores diuretic efficacy. However, in the course of a UF session, patients are exposed to rapid variations of body fluid composition so that, as fluid is withdrawn from the intravascular compartment, hypotension or even shock could occur.

METHODS

In 24 patients with rCHF undergoing UF, we measured, after every liter of plasma water removed, hemodynamics, blood gas analysis (in both systemic and pulmonary arteries), plasma volume changes (PV) and plasma refilling rate (PRR). The PV and PRR were calculated by considering hematocrit and ultrafiltrate volume.

RESULTS

In all patients, UF was performed safely, without side effects or hemodynamic instability (ultrafiltrate = 4,880 ± 896 ml). Mean right atrial, pulmonary artery and wedge pressures progressively reduced during the procedure. Cardiac output increased at the end of the procedure and, to a greater extent, 24 h later, in relation to the increase of stroke volume. Heart rate and systemic vascular resistance did not increase, and other peripheral biochemical parameters did not worsen during UF. Intravascular volume remained stable throughout the entire duration of the procedure, indicating that a proportional volume of fluid was refilled from the congested parenchyma.

CONCLUSIONS

In patients with rCHF, subtraction of plasma water by UF is associated with hemodynamic improvement. Fluid refilling from the overhydrated interstitium is the major compensatory mechanism for intravascular fluid removal, and hypotension does not occur when plasma refilling rate is adequate to prevent hypovolemia.

Abbreviations and Acronyms   Ht = hematocrit   NYHA = New York Heart Association   PRR = plasma refilling rate   PV = plasma volume   rCHF = refractory congestive heart failure   UF = extracorporeal ultrafiltration

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