title: Very high volume hemofiltration with the Cascade system in septic shock patients.
abstract: OBJECTIVE
  We compared hemodynamic and biological effects of the Cascade system, which uses very high volume hemofiltration (HVHF) (120 mL kg(-1) h(-1)), with those of usual care in patients with septic shock.
  
  
  METHODS
  Multicenter, prospective, randomized, open-label trial in three intensive care units (ICU). Adults with septic shock with administration of epinephrine/norepinephrine were eligible. Patients were randomized to usual care plus HVHF (Cascade group), or usual care alone (control group). Primary end point was the number of catecholamine-free days up to 28 days after randomization. Secondary end points were number of days free of mechanical ventilation, renal replacement therapy (RRT) or ICU up to 90 days, and 7-, 28-, and 90-day mortality.
  
  
  RESULTS
  We included 60 patients (29 Cascade, 31 usual care). Baseline characteristics were comparable. Median number of catecholamine-free days was 22 [IQR 11-23] vs 20 [0-25] for Cascade vs control; there was no significant difference even after adjustment. There was no significant difference in number of mechanical ventilation-free days or ICU requirement. Median number of RRT-free days was 85 [46-90] vs 74 [0-90] for Cascade vs control groups, p = 0.42. By multivariate analysis, the number of RRT-free days was significantly higher in the Cascade group (up to 25 days higher after adjustment). There was no difference in mortality at 7, 28, or 90 days.
  
  
  CONCLUSIONS
  Very HVHF using the Cascade system can safely be used in patients presenting with septic shock, but it was not associated with a reduction in the need for catecholamines during the first 28 days.
authors.affiliation: Intensive Care Unit, University Hospital of Dijon, Dijon, France. jean-pierre.quenot@chu-dijon.fr.|Clinical Epidemiology Unit, INSERM, CIC1432, Dijon, France. jean-pierre.quenot@chu-dijon.fr.|Lipness Team, INSERM, Research Center UMR866 and LabEx LipSTIC, Université de Bourgogne, Dijon, France. jean-pierre.quenot@chu-dijon.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.affiliation: Clinical Epidemiology Unit, INSERM, CIC1432, Dijon, France.|Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon University Hospital, Dijon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.affiliation: Intensive Care Unit, Hospital of Melun, Melun, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.affiliation: Intensive Care Unit, University of Nimes, Nimes, France.
authors.forename: Saber-David
authors.initials: SD
authors.lastname: Barbar
authors.affiliation: Clinical Epidemiology Unit, INSERM, CIC1432, Dijon, France.|Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon University Hospital, Dijon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vinault
authors.affiliation: Lipness Team, INSERM, Research Center UMR866 and LabEx LipSTIC, Université de Bourgogne, Dijon, France.|Clinical Research Department, University Hospital of Dijon, Dijon, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Deckert
authors.affiliation: Lipness Team, INSERM, Research Center UMR866 and LabEx LipSTIC, Université de Bourgogne, Dijon, France.|Clinical Research Department, University Hospital of Dijon, Dijon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Lemaire
authors.affiliation: Intensive Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Ali Ait
authors.initials: AA
authors.lastname: Hassain
authors.affiliation: Intensive Care Unit, University Hospital of Dijon, Dijon, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Bruyère
authors.affiliation: Intensive Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.affiliation: Lipness Team, INSERM, Research Center UMR866 and LabEx LipSTIC, Université de Bourgogne, Dijon, France.|Clinical Research Department, University Hospital of Dijon, Dijon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lagrost
authors.affiliation: Intensive Care Unit, Hospital of Melun, Melun, France.|Physiology Department, Cochin Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
mesh_terms: D000368:Aged; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000628:therapy*
keywords: Amino acids; Cytokines; Hemofiltration; Septic shock