Safety of granulocyte colony-stimulating factor (filgrastim) in intubated patients in the intensive care unit: interim analysis of a prospective, placebo-controlled, double-blind study.
OBJECTIVE
To investigate the safety of the granulocyte colony-stimulating factor filgrastim in the prevention of nosocomial infections in intubated patients in the intensive care unit (ICU), with special emphasis on the possible deleterious effect on acute respiratory distress syndrome (ARDS) and the development of multiple organ dysfunction (MOD).


METHODS
Predetermined, interim analysis of a prospective, randomized, placebo-controlled, double-blind trial.


METHODS
University hospital medical-surgical ICU.


METHODS
A total of 59 consecutive ICU patients, aged >18 yrs, admitted to the ICU no more than 12 hrs before the study, intubated because of ventilatory insufficiency no more than 48 hrs before the study, expected to stay in the ICU for >48 hrs, and had informed consent from the next relative.


METHODS
Patients were randomized to receive either placebo or 300 microg of filgrastim subcutaneously once daily for 7 days.


RESULTS
No significant differences were found in the number of patients developing ARDS (2 of 20 in the placebo group vs. 0 of 22 in the filgrastim group), disseminated intravascular coagulation (3 of 27 vs. 3 of 29), acute renal failure (1 of 27 vs. 1 of 23), or change in MOD. Data analysis showed nosocomial infections in 11 of 29 patients in the placebo group and in 7 of 30 patients in the filgrastim group (p = .266). The median (range) length of ICU stay was 8 (1-34) days in the placebo group and 6 days (1-28) in the filgrastim group. The day 28 mortality rate was 17% (5 of 29) in the placebo group and 13% (4 of 30) in the filgrastim group. No drug-related adverse events occurred.


CONCLUSIONS
Filgrastim is safe in intubated ICU patients, with no excess risk for development of ARDS or MOD.
Pettilä
V
V
Department of Surgery, Helsinki University Central Hospital, Finland. Ville.Pettila@Helsinki.fi
Takkunen
O
O
Varpula
T
T
Markkola
A
A
Porkka
K
K
Valtonen
V
V
D000328:Adult; D000368:Aged; D003422:Critical Care; D003428:Cross Infection / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000517:prevention & control; D011446:Prospective Studies; D011994:Recombinant Proteins; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000517:prevention & control
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim