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Title: A pilot study of high-adsorption hemofiltration in human septic shock.
Austin Authors: Haase, M;Silvester, William;Uchino, Shigehiko;Goldsmith, Donna;Davenport, Piers;Tipping, Peter;Boyce, Neil;Bellomo, Rinaldo 
Affiliation: Intensive Care Unit and Intensive Care Research, Austin Hospital, University of Melbourne, Australia
Issue Date: 1-Feb-2007
Publication information: The International Journal of Artificial Organs; 30(2): 108-17
Abstract: To compare the hemodynamic and biological effects of high-adsorption continuous veno-venous hemofiltration (CVVH) with standard CVVH in septic shock.In a randomized cross-over clinical trial twelve patients with septic shock and multiple organ failure were enrolled at a tertiary intensive care unit. Patients were allocated to either 9 hours of high-adsorption hemofiltration (CVVH with 3 hourly filter change using AN69 hemofilters - 3FCVVH) or 9 hours of standard hemofiltration (CVVH without filter change - 1F-CVVH).Changes in hemodynamic variables, dose of noradrenaline required to maintain a mean arterial pressure greater than 75 mmHg and plasma concentrations of cytokines (IL-6, IL-8, IL-10 and IL-18) were measured. A 9-hour period of 3F-CVVH was associated with greater reduction in noradrenaline dose than a similar period of 1F-CVVH (median reduction: 16 vs. 3.5 microg/min, p=0.036; median percentage reduction: 48.1% vs. 17.5%, p=0.028). Unlike 1F-CVVH, 3F-CVVH was associated with a reduction in the plasma concentration of IL-6, IL-10 and IL-18 at 9 hours and a significant decrease 30 minutes after additional filter changes (IL-6: p<0.01, p<0.01; IL-10: p=0.03, p=0.016 and IL-18: p=0.016, p<0.01, respectively). Both, 3F-CVVH and 1F-CVVH were associated with decreased plasma concentrations of IL-8 at 9 hours (p<0.01, p<0.01, respectively). In a confirmatory ex-vivo experiment IL-6 concentrations substantially decreased during 3F-CVVH (at baseline 511 pg/mL and at end: 21 pg/mL) whereas IL-6 concentrations increased in control blood (at baseline 511 pg/mL and at end: 932 pg/mL).High-adsorption CVVH appears more effective than standard CVVH in decreasing noradrenaline requirements and plasma concentrations of cytokines in septic shock patients.
Gov't Doc #: 17377905
Journal: International Journal of Artificial Organs
Type: Journal Article
Subjects: Acute Kidney Injury.complications.therapy
Aged, 80 and over
Blood Pressure
Heart Rate
Middle Aged
Multiple Organ Failure
Renal Dialysis
Shock, Septic.blood.physiopathology.therapy
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