title: Sustained high-efficiency daily diafiltration using a mediator-adsorbing membrane (SHEDD-fA) in the treatment of patients with severe sepsis.
abstract: Sustained high-efficiency daily diafiltration using a mediator-adsorbing membrane (SHEDD-fA) is an effective, intensive modality for sepsis treatment. Here we describe the effectiveness of SHEDD-fA, which makes the best use of three principles: dialysis, filtration and adsorption, for mediator removal in the treatment of severe sepsis. SHEDD-fA was initiated after adequate fluid resuscitation and catecholamine support had been provided. A large (2.1 m(2)) polymethylmethacrylate membrane dialyzer was placed in the blood circuit. Operation conditions were as follows: blood flow rate 150 ml/min, filtration rate 1,500 ml/h (post-dilution), and dialysate flow rate 300-500 ml/min over 8-12 h daily. 55 consecutive patients with severe sepsis were studied. The following results were obtained: pressure catecholamine index significantly decreased at 3 h after initiation of septic shock, PaO(2)/F(IO2) significantly increased at 1 h after initiation of septic acute respiratory distress syndrome, a significant decrease in interleukin (IL)-6 level for 3 days was observed, and IL-6 was effectively adsorbed in one pass through the filter. The average sequential organ failure assessment score of patients was 10.1 and the mortality at 28 days was 16.4% (46 survived, 9 died). Because SHEDD-fA is an intensive and high-efficiency modality, removal of useful drugs or nutrients may be observed. Despite the fact that removal of useful substances cannot be ignored, we believe that an appropriate stage or timing can be identified so that we can avoid a vicious cycle and use blood purification with effective diffusion, filtration and adsorption. We demonstrate that SHEDD-fA may be an effective, intensive modality for the treatment of patients with severe sepsis and is a possible modality for cytokine modulation therapy.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishida
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Naohide
authors.initials: N
authors.lastname: Kuriyama
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hara
authors.forename: Miho
authors.initials: M
authors.lastname: Yumoto
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Shimomura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Moriyama
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000628:therapy; D000327:Adsorption; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D002395:Catecholamines / Q000145:classification / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy; D006684:HLA-DR Antigens / Q000032:analysis; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000628:therapy; D010100:Oxygen / Q000097:blood; D019904:Polymethyl Methacrylate; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002395:Catecholamines; D006684:HLA-DR Antigens; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D008567:Membranes, Artificial; D019904:Polymethyl Methacrylate; D010100:Oxygen