High-volume haemofiltration in human septic shock.
OBJECTIVE
To evaluate whether high volume haemofiltration improves haemodynamics and affects serum cytokine and complement concentrations in human septic shock.


METHODS
Randomized cross-over clinical trial in a tertiary intensive care unit.


METHODS
Eleven patients with septic shock and multi-organ failure.


METHODS
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.


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.
Cole
L
L
Department of Intensive Care, Austin & Repatriation Medical Centre, Melbourne, Australia.
Bellomo
R
R
Journois
D
D
Davenport
P
P
Baldwin
I
I
Tipping
P
P
D018806:APACHE; D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification / Q000401:mortality / Q000628:therapy*; D009638:Norepinephrine / Q000627:therapeutic use; D012772:Shock, Septic / Q000145:classification / Q000401:mortality / Q000628:therapy*
D016207:Cytokines; D009638:Norepinephrine