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April 2004, Volume 34 Number 4 , p 17 - 17





  • Ultrafiltration in action

  • How does it work?

  • Helping Mr. Calabresi


    PATIENTS WITH SEVERE heart failure typically are treated with various medications, including angiotensin-converting enzyme inhibitors, beta-blockers, diuretics, and inotropic drugs. Although these drugs don't stop disease progression, they may reduce symptoms and improve functional capacity. Over time, however, some patients stop responding to these therapies.

    Low-volume extracorporeal ultrafiltration, a process that removes fluid from the intravascular compartment, can help ease symptoms for these patients. It may even help some patients respond again to conventional drug therapy.

    During fluid removal by ultrafiltration, the patient's intravascular fluid volume remains stable, as fluid shifts from the extravascular space to replace that lost from the vessels. This reduces edema and third-spacing. But because fluid isn't removed from the vascular compartment any faster than it can be recruited from the peripheral tissues, patients don't become hypotensive—the plasma refilling rate is adequate to prevent hypovolemia. The patient's heart rate, blood pressure (BP), and serum electrolytes also remain largely unchanged.

    Ultrafiltration in action

    Consider the case of Dominic Calabresi, 69, who's gained nearly 50 pounds in the last 4 months while on home I.V. dobutamine therapy for heart failure. During a recent clinic visit, Mr. Calabresi complains of several recent episodes of palpitations and feeling faint, and you notice 3+ pitting edema of the lower extremities bilaterally and bilateral jugular vein distension. Your exam also reveals marked hepatomegaly and a grossly distended abdomen.

    You administer supplemental oxygen, attach Mr. Calabresi to a cardiac monitor, and administer 100 mg of furosemide I.V. through his tunneled ...

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