Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome

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dc.contributor.authorLópez, René
dc.contributor.authorPérez-Araos, Rodrigo
dc.contributor.authorSalazar, Álvaro
dc.contributor.authorEspinoza, Mauricio
dc.contributor.authorVial, Cecilia
dc.contributor.authorGraf, Jerónimo
dc.contributor.authorCuiza, Analia
dc.contributor.authorVial, Pablo
dc.date.accessioned2022-03-29T15:06:19Z
dc.date.available2022-03-29T15:06:19Z
dc.date.issued2021
dc.description.abstractBackground: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. Severe cases may be rescued by venoarterial extracorporeal membrane oxygenation (VA ECMO), alongside substantial complications. High volume hemofiltration (HVHF) is a depurative technique that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. Methods: We implemented HVHF before VA ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. Patients were considered HVHF-responders if VA ECMO was avoided and HVHF-nonresponders if VA ECMO support was needed despite HVHF. A targeted-HVHF strategy compounded by aggressive hyperoncotic albumin, sodium bicarbonate, and calcium supplementation plus ultrafiltration to avoid fluid overload was implemented on three patients. Results: Patients had maximum serum lactate of 8.8 (8.7-12.8) mmol/L and a lowest cardiac index of 1.8 (1.8-1.9) L/min/m2 . The first two required VA ECMO. They were connected later to HVHF, displayed progressive tachycardia and declining stroke volume. The opposite was true for HVHF-responders who received targeted-HVHF. All patients survived, but one of the VA ECMO patients suffered a vascular complication. Conclusion: HVHF may contribute to support severe HCPS patients avoiding the need for VA ECMO in some. Early connection and targeted-HVHF may increase the chance of success.es
dc.description.versionVersión Publicadaes
dc.identifier.citationLópez R, Pérez-Araos R, Salazar Á, Espinoza M, Vial C, Cuiza A, Vial PA, Graf J. Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome. J Med Virol. 2021 Aug;93(8):4738-4747. doi: 10.1002/jmv.26930. Epub 2021 Mar 23. PMID: 33710670; PMCID: PMC8359853.es
dc.identifier.urihttps://doi.org/10.1002/jmv.26930es
dc.identifier.urihttp://hdl.handle.net/11447/5843
dc.language.isoenes
dc.relation.projectFondo Nacional de Investigación en Salud (FONIS), Grant/Award Number: SAO7120045; Fondo Nacional de Ciencia y Tecnología (Fondecyt), Grant/Award Numbers: 1161447, 1201240es
dc.subjectAndes Hantaviruses
dc.subjectHantavirus cardiopulmonary syndromees
dc.subjectHantavirus pulmonary syndromees
dc.subjectHigh volume hemofiltrationes
dc.subjectTranspulmonary thermodilutiones
dc.subjectVenoarterial extracorporeal membrane oxygenationes
dc.titleTargeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndromees
dc.typeArticlees
dcterms.sourceJournal of Medical Virologyes

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