Effect of high volume hemodiafiltration on oxygenation and ventilatory function in mechanically ventilated patients with Sepsis: a randomized controlled trial

Moeen, Seham Mohamed; Mohammed, Ayman Abd El-Khalek; Abd El-Latif, Mohammed Mohammed; Ibrahim, Abd El Rady Shehata; Mandour, Ahmed Mohamed

doi:10.21608/jicem.2025.407184

	Effect of high volume hemodiafiltration on oxygenation and ventilatory function in mechanically ventilated patients with Sepsis: a randomized controlled trial
The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 5, Issue 1, January 2025, Page 59-83 PDF (610.38 K)
Document Type: Original papers
DOI: 10.21608/jicem.2025.407184
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Authors
Seham Mohamed Moeen ; Ayman Abd El-Khalek Mohammed; Mohammed Mohammed Abd El-Latif; Abd El Rady Shehata Ibrahim; Ahmed Mohamed Mandour
Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of medicine, Assiut University, Assiut, Egypt
Abstract
Background: High volume hemodiafiltration (HVHDF) has been used in patients with sepsis to potentially improve hemodynamics and increase survival rates. We aimed to assess the effect of HVHDF on oxygenation in mechanically ventilated septic patients. We hypothesized that HVHDF could improve oxygenation. Methods: In this prospective, non-blinded, single-institution randomized trial, forty patients were randomly assigned to receive HVHDF (n = 20) or not (n = 20). Patients in the HVHDF group received HVHDF at a prescribed dose of 70 ml/kg/ hours for 48 hours in addition to their usual treatments. Results: At 24 hours and 48 hours after the initiation of HVHDF, the arterial oxygen pressure (PaO₂), the ratio of arterial oxygen pressure to the fraction of inspired oxygen (PaO₂/ FiO₂ ratio), and jugular venous oxygen saturation (S_JVO₂) were all significantly higher in the HVHDF group compared to the non-HVHDF group (P < 0.05). Compared to the non-HVHDF group, the alveolar-arterial oxygen pressure difference (P_A-aO₂) and serum Interleukin- 6 were significantly lower, dynamic compliance increased more significantly, and plateau pressure decreased more significantly in the HVHDF group (P < 0.05) at 48 hours after initiation of HVHDF. Duration for weaning from mechanical ventilation (MV) was significantly shorter in the HVHDF group (P = 0.001). However, serum lactate levels, success of weaning from MV, and 28-day survival were not different between the groups (P > 0.05). Conclusions: In mechanically ventilated septic patients, treatment with HVHDF, in addition to standard therapies, improved oxygenation and ventilatory function, and reduced the duration of MV.
Keywords
Septic shock; Sepsis; High volume hemodiafiltration (HVHDF); Renal replacement therapy; Sequential organ failure assessment (SOFA)


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