title: Hemofiltration with the Cascade system in an experimental porcine model of septic shock.
abstract: High-volume hemofiltration (HVHF) has been suggested as an adjuvant treatment of septic shock because of its capacities to remove inflammatory mediators from blood. Nevertheless, HVHF presents some important drawbacks, such as the depletion of low molecular weight molecules (nutriments, vitamins, trace elements and antibiotics) due to the high ultrafiltration rate, or the significant financial cost and nursing workload due to the frequent changes of large amounts of expensive sterile substitution fluids. A new hemofiltration system called "Cascade" has been developed, allowing very high ultrafiltration rates (120 mL/kg/h) limiting these drawbacks by using a special extracorporeal circuit. The objective of this study was to assess the technical feasibility of the Cascade system and to compare its hemodynamic impact to that of the standard HVHF system. Twenty sepsis-induced pigs were randomized in two groups: one group was hemofiltered with the standard HVHF system and the other with the Cascade system during a six-hour session. No technical problems were observed with the Cascade system during the experiment. At the end of the experiment, colloid requirements (989 +/- 355 mL vs. 1913 +/- 538 mL, P = 0.006), epinephrine requirements (0.82 +/- 0.42 mg vs. 3.27 +/- 3.02 mg, P < 0.001), lactic acidosis (pH = 7.33 +/- 0.08 vs. 7.10 +/- 0.07, P < 0.001) and mean pulmonary arterial pressure were less pronounced in the Cascade group. These results suggest that Cascade hemofiltration is technically feasible and safe. Moreover, compared with standard HVHF, it can reduce the severity of porcine septic shock.
authors.affiliation: Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital, Lyon, France. thmrimmele@aol.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Wey
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bernard
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Semenzato
authors.forename: Farida
authors.initials: F
authors.lastname: Benatir
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boselli
authors.forename: Jérôme
authors.initials: J
authors.lastname: Etienne
authors.forename: Joëlle
authors.initials: J
authors.lastname: Goudable
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: D000140:Acidosis, Lactic / Q000209:etiology; D000322:Adrenergic Agonists / Q000008:administration & dosage; D000818:Animals; D001794:Blood Pressure; D003102:Colloids / Q000008:administration & dosage; D004195:Disease Models, Animal; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods*; D018836:Inflammation Mediators / Q000378:metabolism*; D011897:Random Allocation; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000628:therapy*; D013552:Swine
chemical_list: D000322:Adrenergic Agonists; D003102:Colloids; D018836:Inflammation Mediators; D004837:Epinephrine