[Continuous arteriovenous hemofiltration in the management of patients with shock and multiorgan insufficiency syndrome].

Spontaneous continuous arterio-venous hemofiltration (CAVH) is a blood purification system based on blood filtration through capillary hemofilters without pumps, using the arterio-venous pressure gradient for blood perfusion. In 2-nd Department of Surgery of Medical University of Gdańsk in the years 1989-1996 we introduced CAVH 13 times in 6 women and 7 men, aged from 17 till 79 years. We used this technique to maintain fluid balance in anuric patients needing parenteral fluids. Due to circulatory and respiratory insufficiency all patients needed catecholamines infusion and controlled respiration. In 7 patients acute renal failure was caused by septic shock and in 6 patients by shock after severe multiorgan injuries. The CAVH therapy lasted from 3 till 16 days. The stabilisation of hemodynamic and renal parameters was observed in all patients. 3 patients died of cranio-cerebral injuries and 2 due to longlasting septic shock induced by necrotic pancreatitis. In all patients CAVH was required to remove the excess water given as carrier in total parenteral nutrition. Experience with 13 cases has shown the CAVH technique, to be particularly useful in patients with vascular instability or severe fluid overload. The above method which needs no technical investment is simple to handle.