A phase II randomized, controlled trial of continuous hemofiltration in sepsis

Louise Cole, Rinaldo Bellomo, Graeme Hart, Didier Journois, Piers Davenport, Peter Tipping, Claudio Ronco

Research output: Contribution to journalArticleResearchpeer-review

224 Citations (Scopus)

Abstract

Objective: To study the effect of early and continuous venovenous hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design: Randomized, controlled trial. Setting: Intensive care unit of a tertiary hospital. Patients: Twenty-four patients with early septic shock or septic organ dysfunction. Interventions: Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration. Measurements and Main Results: We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor α at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 ± 19.7) and CVVH survivors (33.2 ± 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 ± 1.9) and all CVVH subjects (3.3 ± 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions: Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

Original languageEnglish
Pages (from-to)100-106
Number of pages7
JournalCritical Care Medicine
Volume30
Issue number1
DOIs
Publication statusPublished - 1 Jan 2002
Externally publishedYes

Keywords

  • Anaphylatoxins
  • Complement
  • Cytokines
  • Hemofiltration
  • Interleukin 10
  • Interleukin 6
  • Interleukin 8
  • Multiple organ failure
  • Septic shock
  • Tumor necrosis factor

Cite this

Cole, Louise ; Bellomo, Rinaldo ; Hart, Graeme ; Journois, Didier ; Davenport, Piers ; Tipping, Peter ; Ronco, Claudio. / A phase II randomized, controlled trial of continuous hemofiltration in sepsis. In: Critical Care Medicine. 2002 ; Vol. 30, No. 1. pp. 100-106.
@article{5e89c18f5c244cce906dc4612d7e69c5,
title = "A phase II randomized, controlled trial of continuous hemofiltration in sepsis",
abstract = "Objective: To study the effect of early and continuous venovenous hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design: Randomized, controlled trial. Setting: Intensive care unit of a tertiary hospital. Patients: Twenty-four patients with early septic shock or septic organ dysfunction. Interventions: Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration. Measurements and Main Results: We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor α at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 ± 19.7) and CVVH survivors (33.2 ± 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 ± 1.9) and all CVVH subjects (3.3 ± 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions: Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.",
keywords = "Anaphylatoxins, Complement, Cytokines, Hemofiltration, Interleukin 10, Interleukin 6, Interleukin 8, Multiple organ failure, Septic shock, Tumor necrosis factor",
author = "Louise Cole and Rinaldo Bellomo and Graeme Hart and Didier Journois and Piers Davenport and Peter Tipping and Claudio Ronco",
year = "2002",
month = "1",
day = "1",
doi = "10.1097/00003246-200201000-00016",
language = "English",
volume = "30",
pages = "100--106",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams & Wilkins",
number = "1",

}

A phase II randomized, controlled trial of continuous hemofiltration in sepsis. / Cole, Louise; Bellomo, Rinaldo; Hart, Graeme; Journois, Didier; Davenport, Piers; Tipping, Peter; Ronco, Claudio.

In: Critical Care Medicine, Vol. 30, No. 1, 01.01.2002, p. 100-106.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A phase II randomized, controlled trial of continuous hemofiltration in sepsis

AU - Cole, Louise

AU - Bellomo, Rinaldo

AU - Hart, Graeme

AU - Journois, Didier

AU - Davenport, Piers

AU - Tipping, Peter

AU - Ronco, Claudio

PY - 2002/1/1

Y1 - 2002/1/1

N2 - Objective: To study the effect of early and continuous venovenous hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design: Randomized, controlled trial. Setting: Intensive care unit of a tertiary hospital. Patients: Twenty-four patients with early septic shock or septic organ dysfunction. Interventions: Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration. Measurements and Main Results: We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor α at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 ± 19.7) and CVVH survivors (33.2 ± 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 ± 1.9) and all CVVH subjects (3.3 ± 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions: Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

AB - Objective: To study the effect of early and continuous venovenous hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design: Randomized, controlled trial. Setting: Intensive care unit of a tertiary hospital. Patients: Twenty-four patients with early septic shock or septic organ dysfunction. Interventions: Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration. Measurements and Main Results: We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor α at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 ± 19.7) and CVVH survivors (33.2 ± 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 ± 1.9) and all CVVH subjects (3.3 ± 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions: Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

KW - Anaphylatoxins

KW - Complement

KW - Cytokines

KW - Hemofiltration

KW - Interleukin 10

KW - Interleukin 6

KW - Interleukin 8

KW - Multiple organ failure

KW - Septic shock

KW - Tumor necrosis factor

UR - http://www.scopus.com/inward/record.url?scp=0036154952&partnerID=8YFLogxK

U2 - 10.1097/00003246-200201000-00016

DO - 10.1097/00003246-200201000-00016

M3 - Article

C2 - 11902250

AN - SCOPUS:0036154952

VL - 30

SP - 100

EP - 106

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 1

ER -