title: High-volume haemofiltration with a new haemofiltration membrane having enhanced adsorption properties in septic pigs.
abstract: BACKGROUND
  High-volume haemofiltration (HVHF) has been suggested as an adjuvant treatment of septic shock due to its capacities to remove from blood both pro- and anti-inflammatory mediators involved in the sepsis syndrome. Adsorption properties of some haemofiltration membranes are also interesting with this indication because inflammatory mediators are caught in the membrane itself. The aim of this study was to determine the haemodynamic and immunological effects of a new haemofiltration membrane, which has enhanced adsorption properties due to a special surface treatment, allowing the adsorption of endotoxins.
  
  
  METHODS
  We compared this membrane to a standard haemofiltration membrane both in vitro and in 20 sepsis-induced pigs, randomized in two groups. One group was haemofiltered with the treated membrane and the other with the standard haemofiltration membrane during 6-h HVHF sessions.
  
  
  RESULTS
  At the end of the experiment, mean +/- SD crystalloids requirements (5937 +/- 1588 versus 7587 +/- 1456 ml, P = 0.026), colloids requirements (1437 +/- 320 versus 1912 +/- 538 ml, P = 0.027), lactic acidosis (pH = 7.20 +/- 0.11 versus 7.10 +/- 0.07, P = 0.026) and pulmonary arterial hypertension (MPAP = 24 +/- 7 versus 34 +/- 8 mmHg, P = 0.008) were less pronounced when HVHF was performed with the treated membrane. In addition, mean +/- SD endotoxins levels were lower in the treated membrane group after 1 hour of HVHF (1.91 +/- 1.19 versus 11.07 +/- 10.64 EU/ml, P = 0.035). Cytokines levels were not different between groups except for IL-1beta, which was slightly lower in the treated membrane group.
  
  
  CONCLUSIONS
  The use of a membrane with enhanced adsorption properties during a 6-h HVHF session in septic pigs improves haemodynamics compared to a standard haemofiltration membrane. These results are probably due to an efficient endotoxins and cytokines adsorption. A human study using this membrane is now necessary to confirm these results.
authors.affiliation: Department of Anesthesiology and Intensive Care, Pavilion P, Edouard Herriot Hospital, Lyon, France. thmrimmele@aol.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.forename: Abdulnasser
authors.initials: A
authors.lastname: Assadi
authors.forename: Mathilde
authors.initials: M
authors.lastname: Cattenoz
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe
authors.forename: Corine
authors.initials: C
authors.lastname: Lambert
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boselli
authors.forename: Joëlle
authors.initials: J
authors.lastname: Goudable
authors.forename: Jérôme
authors.initials: J
authors.lastname: Etienne
authors.forename: Dominique
authors.initials: D
authors.lastname: Chassard
authors.forename: Giampiero
authors.initials: G
authors.lastname: Bricca
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: D000180:Acrylic Resins; D000327:Adsorption; D000818:Animals; D020099:Coated Materials, Biocompatible; D016207:Cytokines / Q000097:blood / Q000302:isolation & purification; D004195:Disease Models, Animal; D004731:Endotoxins / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation* / Q000379:methods; D066298:In Vitro Techniques; D018836:Inflammation Mediators / Q000097:blood / Q000302:isolation & purification; D008422:Materials Testing; D008567:Membranes, Artificial; D018805:Sepsis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D034421:Sus scrofa
chemical_list: D000180:Acrylic Resins; D020099:Coated Materials, Biocompatible; D016207:Cytokines; D004731:Endotoxins; D018836:Inflammation Mediators; D008567:Membranes, Artificial; C010504:polyacrylonitrile