ACUTE HEMODIALYSIS IN THE SURGICAL INTENSIVE-CARE UNIT

  • 1 September 1988
    • journal article
    • research article
    • Vol. 54  (9) , 548-552
Abstract
Records of postoperative patients requiring acute hemodialysis admitted to the surgical intensive care unit from January 1, 1984 to June 30, 1986 were retrospectively reviewed. Twenty one patients, 9 men and 12 women (mean age 72 years) had an overall mortality of 86 per cent. The mortality rate with impaired preoperative renal function (Ccr < 41 ml/min) was 100 per cent versus 80 per cent for patients with normal clearances. Prior to the onset of renal failure nine patients (43%) experienced hypotension and seven (33%) received nephrotoxic drugs or dyes. Blood culture documented sepsis was uniformly fatal. Any additional organ system failure (cardiac, pulmonary, hepatic or hematologic) adversely affected survival (P < 0.01). Nineteen of twenty patients (95%) were fluid overloaded (mean 10.0L) at dialysis institution, determined by measured output over input. Commonly observed cardiac and/or pulmonary system failure is exacerbated by overhydration, therefore early dialysis and/or judicious fluid restriction may be preventative and could improve survival.

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