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Intensive Care Medicine

, Volume 34, Issue 9, pp 1646–1653 | Cite as

A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock

  • Nicolas Boussekey
  • Arnaud Chiche
  • Karine Faure
  • Patrick Devos
  • Benoit Guery
  • Thibaud d’Escrivan
  • Hugues Georges
  • Olivier Leroy
Original

Abstract

Objective

High volume hemofiltration (HVHF) has shown potential benefits in septic animals and a few reports suggested a hemodynamic improvement in humans. However, randomized studies are still lacking. Our goal was to evaluate the hemodynamic effects of HVHF in septic shock patients with acute renal failure (ARF).

Design and setting

Prospective randomized study in an intensive care unit (ICU).

Patients

Twenty patients with septic shock and ARF.

Interventions

Patients were randomized to either high volume hemofiltration [HVHF 65 ml/(kg h)] or low volume hemofiltration [LVHF 35 ml/(kg h). Vasopressor dose was adjusted to reach a mean arterial pressure (MAP) > 65 mmHg.

Measurements and results

We performed six hourly measurements of MAP, norepinephrine dose, PaO2/FiO2 and lactate, and four daily urine output and logistic organ dysfunction (LOD) score. Baseline characteristics of the two groups were comparable on randomization. Mean norepinephrine dose decreased more rapidly after 24 h of HVHF treatment compared to LVHF treatment (P = 0.004) whereas lactate and PaO2/FiO2 did not differ between the two treatment groups. During the 4-day follow-up, urine output was slightly increased in the HVHF group (P = 0.059) but the LOD score evolution was not different. Duration of mechanical ventilation, renal replacement therapy and ICU length of stay were also comparable. Survival on day 28 was not affected.

Conclusion

HVHF decreased vasopressor requirement and tended to increase urine output in septic shock patients with renal failure. However, a larger trial is required to confirm our results and perhaps to show a benefit in survival.

Keywords

High volume hemofiltration Septic shock Acute renal failure Vasopressor Randomized study 

Notes

Acknowledgments

Tourcoing hospital provided the financial support for this study.

Conflict of Interest

The authors have no financial involvement with any organization or entity with a financial interest in the subject discussed in the manuscript.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Nicolas Boussekey
    • 1
  • Arnaud Chiche
    • 2
  • Karine Faure
    • 4
  • Patrick Devos
    • 3
  • Benoit Guery
    • 4
  • Thibaud d’Escrivan
    • 2
  • Hugues Georges
    • 2
  • Olivier Leroy
    • 2
  1. 1.Intensive Care and Infectious Disease UnitTourcoing HospitalTourcoing cedexFrance
  2. 2.Intensive Care and Infectious Disease UnitTourcoing Hospital, University of Lille IILilleFrance
  3. 3.Department of BiostatisticsUniversity of Lille IILilleFrance
  4. 4.Infectious Diseases Unit, CHRU LilleUniversity of Lille IILilleFrance

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