الفهرس 
Acknowledgement
The Search for a Perfect Sepsis MarkerOnly 14 pages are availabe for public view
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Abstract
High volume hemodiafiltration (HVHDF) has been used in septic patients to get hemodynamic improvement and possibly survival benefit. We aimed to evaluate the effect of HVHDF on lung mechanics and cytokines removal in mechanically ventilated septic patients. Forty patients with sepsis and ARDS, mechanically ventilated with multi-organ failure were included in this study from July 2017 to February 2019 after approval by our local research ethics committee. An informed consent was obtained from all the patients’ relatives before enrollment. Patients were classified into two equal groups (20 each). group (A) received HVHDF and group (B) didn’t receive HVHDF (control group). In both groups, standardized mechanical ventilation parameters were received. Data were collected at start of study (Day 0), 24 hours (Day 1), and 48 hours (Day 2) thereafter. Patients were compared as regards the lung mechanics, ratio of arterial oxygen pressure to fraction of inspired oxygen, alveolar-arterial oxygen pressure difference, jugular venous oxygen saturation, serum IL-6 , SOFA score, serum lactate, MAP, dose of noradrenaline infusion, UOP, temperature, weaning from mechanical ventilation, 28 days survival, and follow up investigations. Reported adverse effects of HVHDF were recorded. No significant changes were found in values of static compliance, dynamic compliance, PEEP needed, plateau pressure, peak airway pressure, and airway resistance except at Day 2 where dynamic compliance was significantly higher and plateau pressure was significantly lower in HVHDF group. There were significant improvement in PaO2/FiO2 ratio in HVHDF group at Day 1 and Day 2. There was significant improvement in alveolar–arterial oxygen pressure difference in HVHDF group at Day 2. Jugular venous oxygen saturation was significantly higher in HVHDF group at Day 1 and Day 2 compared to non-HVHDF group. There were insignificant differences between both groups in serum IL- 6 at Day 0 and Day 1, while it was significantly lower in HVHDF group than in non-HVHDF group at Day 2. Total SOFA score was significantly lower at Day 1 and Day 2 in HVHDF group. No significant changes were reported in serum lactate between the two studied groups. In both groups, jugular venous oxygen saturation and serum lactate were weakly correlated with serum IL-6 levels at Day 1 and Day 2. There were no significant changes between both groups in MAP, dose of noradrenaline infusion, UOP and body temperature at Day 0. At Day 1, UOP and body temperature were significantly lower and at Day 2, dose of noradrenaline infusion and body temperature were significantly lower in HVHDF group compared to non-HVHDF group. Success of weaning from mechanical ventilation was similar between both groups. Days required for weaning was significantly less in HVHDF group compared to non-HVHDF group. No difference between both groups in 28 days survival was found. Serum creatinine, serum urea and total bilirubin levels were significantly lower in HVHDF group at Day 2 than non- HVHDF group. Initial transient hypotension, hypothermia, heparin induced thrombocytopenia, haemolysis, and bleeding were reported in HVHDF group. We concluded that, HVHDF improved oxygenation, SOFA score, dynamic compliance, plateau pressure, and jugular venous oxygen saturation. Additionally, it lowered serum IL- 6 and decreased days for weaning in mechanically ventilated septic patients with multi-organ failure.