High-volume haemofiltration in human septic shock

L. Cole, R. Bellomo, D. Journois, P. Davenport, I. Baldwin, P. Tipping

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Abstract

Objective: To evaluate whether high volume haemofiltration improves haemodynamics and affects serum cytokine and complement concentrations in human septic shock. Design and setting: Randomized cross-over clinical trial in a tertiary intensive care unit. Patients: Eleven patients with septic shock and multi-organ failure. Interventions: Patients were assigned to either 8 h of high-volume haemofiltration (HVHF; 6 l/h) or 8 h of standard continuous veno-venous haemofiltration (CVVH; 1 l/h) in random order. Measurements and main results: We measured changes in haemodynamic variables, dose of norepinephrine required to maintain a mean arterial pressure greater than 70 mmHg and plasma concentrations of complement anaphylatoxins and several cytokines. An 8-h period of HVHF was associated with a greater reduction in norepinephrine requirements than a similar period of CVVH (median reduction: 10.5 vs. 1.0 μg/min; p = 0.01; median percentage reduction: 68 vs. 7%; p = 0.02). Both therapies were associated with a temporary reduction (p < 0.01) in the plasma concentration of C3a, C5a, and interleukin 10 within 2 h of initiation. HVHF was associated with a greater reduction in the area under the curve for C3a and C5a (p < 0.01). The concentration of the measured soluble mediators in the ultrafiltrate was negligible. Conclusions: HVHF decreases vasopressor requirements in human septic shock and affects anaphylatoxin levels differently than standard CVVH.

Original languageEnglish
Pages (from-to)978-986
Number of pages9
JournalIntensive Care Medicine
Volume27
Issue number6
DOIs
Publication statusPublished - 30 Jul 2001
Externally publishedYes

Keywords

  • Acute renal failure
  • Haemodialysis
  • Haemofiltration
  • Multi-organ failure
  • Sepsis
  • Septic shock
  • Shock

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