title: In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients.
abstract: Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to systemic inflammatory response syndrome (SIRS) with concomitant organ malfunction. Infused particles may exacerbate inflammatory syndromes since they activate the coagulation cascade and alter inflammatory response or microvascular perfusion. In a randomized, controlled, prospective trial, we have previously shown that particle-retentive in-line filtration prevented major complications in critically ill children. Now, we investigated the effect of in-line filtration on major complications in the subgroup of cardiac patients. Children admitted to tertiary pediatric intensive care unit were randomized to either control or filter group obtaining in-line filtration throughout complete infusion therapy. Risk differences and 95 % confidence intervals (CI) of several complications such as SIRS, sepsis, mortality, various organ failure and dysfunction were compared between both groups using the Wald method. 305 children (n = 150 control, n = 155 filter group) with cardiac diseases were finally analyzed. The majority was admitted after cardiac surgery with CPB. Risk of SIRS (-11.3 %; 95 % CI -21.8 to -0.5 %), renal (-10.0 %; 95 % CI -17.0 to -3.0 %) and hematologic (-8.1 %; 95 % CI -14.2 to -0.2 %) dysfunction were significantly decreased within the filter group. No risk differences were demonstrated for occurrence of sepsis, any other organ failure or dysfunctions between both groups. Infused particles might aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction in pediatric cardiac intensive care patients. Particle-retentive in-line filtration might be effective in preventing SIRS and maintaining renal and hematologic function. In-line filtration offers a novel therapeutic option to decrease morbidity in cardiac intensive care.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sasse
authors.forename: Friederike
authors.initials: F
authors.lastname: Dziuba
authors.forename: Thomas
authors.initials: T
authors.lastname: Jack
authors.forename: Harald
authors.initials: H
authors.lastname: Köditz
authors.forename: Torsten
authors.initials: T
authors.lastname: Kaussen
authors.forename: Harald
authors.initials: H
authors.lastname: Bertram
authors.forename: Philipp
authors.initials: P
authors.lastname: Beerbaum
authors.forename: Martin
authors.initials: M
authors.lastname: Boehne
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D004340:Drug Contamination / Q000517:prevention & control*; D005260:Female; D005374:Filtration / Q000379:methods*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000295:instrumentation / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000517:prevention & control; D052638:Particulate Matter / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000517:prevention & control; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D019851:Thrombophilia / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D052638:Particulate Matter
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