High-volume Haemofiltration in Human Septic Shock

Intensive Care Med. 2001 Jun;27(6):978-86. doi: 10.1007/s001340100963.

Abstract

Objective: To evaluate whether high volume haemofiltration improves haemodynamics and affects serum cytokine and complement concentrations in human septic shock.

Design and setting: Randomized cross-over clinical trial in a tertiary intensive care unit.

Patients: Eleven patients with septic shock and multi-organ failure.

Interventions: Patients were assigned to either 8 h of high-volume haemofiltration (HVHF; 6 l/h) or 8 h of standard continuous veno-venous haemofiltration (CVVH; 1 l/h) in random order.

Measurements and main results: We measured changes in haemodynamic variables, dose of norepinephrine required to maintain a mean arterial pressure greater than 70 mmHg and plasma concentrations of complement anaphylatoxins and several cytokines. An 8-h period of HVHF was associated with a greater reduction in norepinephrine requirements than a similar period of CVVH (median reduction: 10.5 vs. 1.0 microg/min; p = 0.01; median percentage reduction: 68 vs. 7%; p = 0.02). Both therapies were associated with a temporary reduction (p < 0.01) in the plasma concentration of C3a, C5a, and interleukin 10 within 2 h of initiation. HVHF was associated with a greater reduction in the area under the curve for C3a and C5a (p < 0.01). The concentration of the measured soluble mediators in the ultrafiltrate was negligible.

Conclusions: HVHF decreases vasopressor requirements in human septic shock and affects anaphylatoxin levels differently than standard CVVH.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Adult
  • Aged
  • Cytokines / blood
  • Female
  • Hemodynamics / drug effects*
  • Hemofiltration / methods*
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure / classification
  • Multiple Organ Failure / mortality
  • Multiple Organ Failure / therapy*
  • Norepinephrine / therapeutic use
  • Shock, Septic / classification
  • Shock, Septic / mortality
  • Shock, Septic / therapy*

Substances

  • Cytokines
  • Norepinephrine