Retrospective Observational Study of Hemodynamic Alterations During Hemodialysis

Corresponding Author:

Shalaka Patil
S.L. Raheja Hospital, Maharashtra, India
Telephone: +917387790242
E-mail: shalaka0202@gmail.com

Abstract

Critically ill patients have unstable hemodynamics when presenting to the ICU. In such instances, procedures like hemodialysis and slow low efficiency daily dialysis may subject the patient to high variability in hemodynamics which may cause increased morbidity and mortality in susceptible individuals. No Indian study has studied the hemodynamic alteration during the initiation of hemodialysis by continuous cardiac output monitoring. Hemodynamic variables of 10 matched patients subjected to hemodynamic monitoring were studied retrospectively and conclusions were drawn. The results of this study help us to understand the hemodynamics at the initiation of dialysis and thus develop protocols for monitoring.

Introduction

In critical care hemodynamic monitoring is used to detect cardiovascular insufficiency, to differentiate contributing factors, to guide therapy. Ultimately the goal is to optimize the delivery of oxygen and nutrients to the tissues. Critically ill patients are often hemodynamically unstable (or at risk of becoming unstable) owing to hypovolemia, cardiac dysfunction, or alterations of vasomotor function, leading to organ dysfunction, deterioration into multiorgan failure, and eventually death. Over the last few decades, hemodynamic monitoring has evolved from basic monitoring of Cardiac Output (CO) to sophisticated devices providing a plethora of variables. CO is the most fundamental hemodynamic parameter. It is measured by various invasive and non-invasive methods based on imaging (Echocardiography/Magnetic Resonance [MR]), oxygen consumption (Fick principle), or indicator dilution techniques. The latter is most widely used in clinical practice and relies on the Stewart-Hamilton equation [volume of injected indicator divided by the Area Under The Dilution Curve (AUC)].

Haemodialysis (HD) patients suffer from high cardiovascular morbidity and mortality. CO monitoring during HD is thought to detect deterioration of systemic hemodynamics before clinical events such as hypotension or syncope occur. Even in the absence of an event, CO monitoring could identify those HD patients with critically low CO-be it at the beginning or at the end of HD that might be a risk factor for sudden death and increased mortality.

This article is set about to understand the various changes in hemodynamics during the initiation of hemodialysis in critical patients with respect to CO, CI, SV, SVV, SVR, SVRI, BP, CVP. We monitored the above values with the help of inserting EV 1000 continuous cardiac output monitoring system in 10 patients in the critical care unit.

Introduction

This is retrospective observational data (collected between January 2019 and December 2019) of 10 patients with chronic renal failure requiring hemodialysis due to volume overload and hyperkalemia. The demographics of the patient were as mentioned in (Table 1). These 10 patients were subjected to hemodialysis in the Intensive Care Unit (ICU). As a protocol in our intensive care unit such patients are subjected to hemodynamic monitoring and consent was sought for insertion of the central line and the femoral line for the EV1000 set up (Edwards Lifesciences, Irvine, USA). A baseline transpulmonary thermodilution was done using 20 ml cold saline followed by which continuous monitoring was done. Hemodynamic parameters like Cardiac Output (CO), Stroke Volume Variation (SVV), Systematic Vascular Resistance (SVR), and Stroke Volume Index (SVI), Systematic Vascular Resistance Index (SVRI), Pulse Rate (PR), Mean Arterial Pressure (MAP), Central Venous Pressure (CVP) were monitored with the help of inserting EV1000 continuous cardiac output monitoring system. The data were collected before initiation of dialysis and after the start of hemodialysis at the interval of every 5 min till 30 minutes.

• Inclusion criteria

Patients admitted to the ICU require conventional hemodialysis due to volume overload and hyperkalemia due to chronic renal failure.

• Exclusion criteria