title: Treatment of septic shock with continuous HDF using 2 PMMA hemofilters for enhanced intensity.
abstract: OBJECTIVE
  Cytokines play pivotal roles in the pathophysiology of severe sepsis/septic shock, and continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) removes cytokines efficiently and continuously, mainly through adsorption to a hemofilter membrane. The aim of this study was to investigate the clinical efficacy of enhanced intensity PMMA-CHDF in treating refractory septic shock.
  
  
  METHODS
  Seventy-two septic shock patients admitted to the intensive care unit (ICU) underwent critical care including PMMA-CHDF. We employed enhanced intensity PMMA-CHDF to improve the cytokine removal rate by increasing the hemofilter membrane area in 10 refractory septic shock patients (enhanced intensity group, EI group; 2 extracorporeal CHDF circuits using the hemofilter with a larger membrane area of 2.1 m2). Other patients undergoing conventional PMMA-CHDF and matched for severity with the EI group, comprised a matched conventional group (MC group; using a PMMA membrane hemofilter with a membrane area of 1.0 m2; n=15). The case-control comparison was performed between the 2 groups.
  
  
  RESULTS
  Enhanced intensity PMMA-CHDF significantly increased mean arterial pressure by 23.8% in 1 hour (p=0.037), decreased the blood lactate level by 28.6% in 12 hours (p=0.006), and reduced blood IL-6 level in 24 hours (p=0.005). The ICU survival rate in the EI group was significantly better than that in the MC group (60% vs. 13.3%, p=0.028).
  
  
  CONCLUSIONS
  Enhanced intensity PMMA-CHDF may improve hemodynamics and survival rate in patients with refractory septic shock.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. yousuke_jpn4035@yahoo.co.jp
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.forename: Tomohito
authors.initials: T
authors.lastname: Sadahiro
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yo
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Eizo
authors.initials: E
authors.lastname: Watanabe
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Abe
authors.forename: Taka-Aki
authors.initials: TA
authors.lastname: Nakada
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tateishi
authors.forename: Taku
authors.initials: T
authors.lastname: Oshima
authors.forename: Koichiro
authors.initials: K
authors.lastname: Shinozaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirasawa
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003422:Critical Care; D004867:Equipment Design; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D007564:Japan; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D008567:Membranes, Artificial; D019344:Lactic Acid; D019904:Polymethyl Methacrylate