Hemodynamic and oxygen measurements were obtained before and during 24 h of continuous arteriovenous hemofiltration (CAVH) in 36 postoperative cardiac surgery patients with severe acute pulmonary failure. During the first 6 h, the low mean arterial pressure averaged only 50 +/- 7 mm Hg; PaO2 was 90 torr on an inspired oxygen fraction of 0.86 +/- 0.03; and lactic acid was 10.5 +/- 6 mmol/L. Of the 34 patients recovering from shock within 12 h, only 24 (67%) were hospital survivors. Cardiac index, oxygen availability index, oxygen consumption, and PaO2 increased during CAVH. This treatment decreased serum levels of the myocardial depressant factor, thus allowing catecholamine support to be reduced. We conclude that CAVH eliminates cardiopulmonary toxic substances partly responsible for shock. Our patients' improved hemodynamic and respiratory function suggests that CAVH may be useful in postoperative cardiac surgery patients with respiratory and hemodynamic failure.