A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock.
OBJECTIVE
High volume hemofiltration (HVHF) has shown potential benefits in septic animals and a few reports suggested a hemodynamic improvement in humans. However, randomized studies are still lacking. Our goal was to evaluate the hemodynamic effects of HVHF in septic shock patients with acute renal failure (ARF).


METHODS
Prospective randomized study in an intensive care unit (ICU).


METHODS
Twenty patients with septic shock and ARF.


METHODS
Patients were randomized to either high volume hemofiltration [HVHF 65 ml/(kg h)] or low volume hemofiltration [LVHF 35 ml/(kg h). Vasopressor dose was adjusted to reach a mean arterial pressure (MAP) > 65 mmHg.


RESULTS
We performed six hourly measurements of MAP, norepinephrine dose, PaO(2)/FiO(2) and lactate, and four daily urine output and logistic organ dysfunction (LOD) score. Baseline characteristics of the two groups were comparable on randomization. Mean norepinephrine dose decreased more rapidly after 24 h of HVHF treatment compared to LVHF treatment (P = 0.004) whereas lactate and PaO(2)/FiO(2) did not differ between the two treatment groups. During the 4-day follow-up, urine output was slightly increased in the HVHF group (P = 0.059) but the LOD score evolution was not different. Duration of mechanical ventilation, renal replacement therapy and ICU length of stay were also comparable. Survival on day 28 was not affected.


CONCLUSIONS
HVHF decreased vasopressor requirement and tended to increase urine output in septic shock patients with renal failure. However, a larger trial is required to confirm our results and perhaps to show a benefit in survival.
Intensive Care and Infectious Disease Unit, Tourcoing Hospital, 135, rue du Président Coty, BP 619, 59208, Tourcoing cedex, France. nboussekey@ch-tourcoing.fr
Nicolas
N
Boussekey
Arnaud
A
Chiche
Karine
K
Faure
Patrick
P
Devos
Benoit
B
Guery
Thibaud
T
d'Escrivan
Hugues
H
Georges
Olivier
O
Leroy
D018806:APACHE; D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000145:classification / Q000150:complications* / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D009638:Norepinephrine