title: In-line filtration minimizes organ dysfunction: new aspects from a prospective, randomized, controlled trial.
abstract: BACKGROUND
  Infused particles induce thrombogenesis, impair microcirculation and modulate immune response. We have previously shown in critically ill children, that particle-retentive in-line filtration reduced the overall complication rate of severe events, length of stay and duration of mechanical ventilation. We now evaluated the influence of in-line filtration on different organ function and thereby elucidated the potential underlying pathophysiological effects of particle infusion.
  
  
  METHODS
  In this single-centre, prospective, randomized controlled trial 807 critically ill children were assigned to either control (n = 406) or filter group (n = 401), the latter receiving in-line filtration for complete infusion therapy. Both groups were compared regarding the differences of incidence rates and its 95% confidence interval (CI) of different organ dysfunction as defined by the International Pediatric Sepsis Consensus Conference 2005.
  
  
  RESULTS
  The incidence rates of respiratory (-5.06%; 95% CI, -9.52 to -0.59%), renal (-3.87%; 95% CI, -7.58 to -0.15%) and hematologic (-3.89%; 95% CI, -7.26 to -0.51%) dysfunction were decreased in the filter group. No difference was demonstrated for the occurrence rates of cardiovascular, hepatic, or neurologic dysfunction between both groups.
  
  
  CONCLUSIONS
  In-line filtration has beneficial effects on the preservation of hematologic, renal and respiratory function in critically ill patients. The presented clinical data further support our hypothesis regarding potential harmful effects of particles. In critically ill patients infused particles may lead to further deterioration of the microcirculation, induce a systemic hypercoagulability and inflammation with consecutive negative effects on organ function.
  
  
  BACKGROUND
  ClinicalTrials.gov number; NCT00209768.
authors: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Martin
authors: M
authors: Boehne
authors: Thomas
authors: T
authors: Jack
authors: Harald
authors: H
authors: Köditz
authors: Kathrin
authors: K
authors: Seidemann
authors: Florian
authors: F
authors: Schmidt
authors: Michaela
authors: M
authors: Abura
authors: Harald
authors: H
authors: Bertram
authors: Michael
authors: M
authors: Sasse
mesh_terms: D002406:Catheterization, Peripheral / Q000295:instrumentation; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000295:instrumentation / Q000379:methods*; D057194:Intention to Treat Analysis; D008297:Male; D008851:Micropore Filters; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control*; D052638:Particulate Matter / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D052638:Particulate Matter
references: Biol Pharm Bull. 2005 Dec;28(12):2268-70
references: 16327163
references: Acta Paediatr. 2004 May;93(5):658-62
references: 15174791
references: Infusionsther Transfusionsmed. 1994 Feb;21(1):52-8
references: 8173313
references: Curr Opin Clin Nutr Metab Care. 2003 May;6(3):319-25
references: 12690266
references: Pediatr Surg Int. 2002 Sep;18(5-6):310-4
references: 12415345
references: Part Fibre Toxicol. 2011 Mar 15;8:12; author reply 12
references: 21406084
references: Pediatr Crit Care Med. 2005 Jan;6(1):2-8
references: 15636651
references: Anaesthesist. 1989 Oct;38(10):544-8
references: 2511778
references: Nutrition. 2001 May;17(5):403-8
references: 11377134
references: Arch Toxicol. 2009 May;83(5):429-37
references: 18953527
references: Virchows Arch Pathol Anat Physiol Klin Med. 1955;327(4):460-79
references: 13299666
references: Intensive Care Med. 2012 Jun;38(6):1008-16
references: 22527062
references: Am J Respir Crit Care Med. 2002 Feb 15;165(4):514-20
references: 11850345
references: Med J Aust. 1964 Jul 4;2:1-6
references: 14175312
references: Intensive Care Med. 2010 Mar;36(3):392-411
references: 19921152
references: PLoS One. 2011 Apr 11;6(4):e18525
references: 21494547
references: Eur J Nucl Med Mol Imaging. 2009 Jun;36(6):1005-8
references: 19190906
references: Arch Dis Child. 1992 Dec;67(12):1475-7
references: 1489228
references: Biomaterials. 2008 Apr;29(12):1912-9
references: 18242692
references: Crit Care. 2005;9 Suppl 4:S13-9
references: 16168069
references: Intensive Care Med. 2010 Apr;36(4):707-11
references: 20165942
references: Thorac Cardiovasc Surg. 1997 Feb;45(1):20-6
references: 9089970
references: Crit Care Med. 2000 Jun;28(6):1871-6
references: 10890635
references: Biol Pharm Bull. 2006 Nov;29(11):2321-3
references: 17077539
references: Intensive Care Med. 2003 Feb;29(2):278-85
references: 12541154
references: Environ Health Perspect. 2006 Mar;114(3):412-9
references: 16507465
references: Cardiovasc Res. 2003 Oct 15;60(1):26-39
references: 14522404
references: Semin Immunopathol. 2012 Jan;34(1):167-79
references: 21805225
references: Clin Occup Environ Med. 2006;5(4):785-96
references: 17110292
references: Anaesthesist. 1989 Nov;38(11):617-21
references: 2635837
references: Contrib Nephrol. 2011;174:89-97
references: 21921613