title: In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial.
abstract: OBJECTIVE
  Particulate contamination due to infusion therapy carries a potential health risk for intensive care patients.
  
  
  METHODS
  This single-centre, prospective, randomized controlled trial assessed the effects of filtration of intravenous fluids on the reduction of complications in critically ill children admitted to a pediatric intensive care unit (PICU). A total of 807 subjects were randomly assigned to either a control (n = 406) or filter group (n = 401), with the latter receiving in-line filtration. The primary endpoint was reduction in the rate of overall complications, which included the occurrence of systemic inflammatory response syndrome (SIRS), sepsis, organ failure (circulation, lung, liver, kidney) and thrombosis. Secondary objectives were a reduction in the length of stay on the PICU and overall hospital stay. Duration of mechanical ventilation and mortality were also analyzed.
  
  
  RESULTS
  Analysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group. In particular, the incidence of SIRS was significantly lower (n = 123 [30.3 %] vs. n = 90 [22.4 %]; P = 0.01). Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97-4.82] vs. 2.98 [2.33-3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6-22.4] vs. 11.0 [7.1-14.9] h; P = 0.028) were significantly reduced.
  
  
  CONCLUSIONS
  In-line filtration is able to avert severe complications in critically ill patients. The overall complication rate during the PICU stay among the filter group was significantly reduced. In-line filtration was effective in reducing the occurrence of SIRS. We therefore conclude that in-line filtration improves the safety of intensive care therapy and represents a preventive strategy that results in a significant reduction of the length of stay in the PICU and duration of mechanical ventilation (ClinicalTrials.gov number: NCT00209768).
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jack
authors.forename: Martin
authors.initials: M
authors.lastname: Boehne
authors.forename: Bernadette E
authors.initials: BE
authors.lastname: Brent
authors.forename: Ludwig
authors.initials: L
authors.lastname: Hoy
authors.forename: Harald
authors.initials: H
authors.lastname: Köditz
authors.forename: Armin
authors.initials: A
authors.lastname: Wessel
authors.forename: Michael
authors.initials: M
authors.lastname: Sasse
mesh_terms: D002648:Child; D016638:Critical Illness; D004340:Drug Contamination / Q000517:prevention & control*; D005260:Female; D005374:Filtration / Q000379:methods*; D005858:Germany; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects*; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies