Intensive Care Medicine

, Volume 27, Issue 6, pp 978–986 | Cite as

High-volume haemofiltration in human septic shock

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

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

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

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • L. Cole
    • 1
  • R. Bellomo
    • 1
  • D. Journois
    • 2
  • P. Davenport
    • 3
  • I. Baldwin
    • 1
  • P. Tipping
    • 3
  1. 1.Department of Intensive Care, Austin & Repatriation Medical Centre, MelbourneAustralia
  2. 2.Department of Anaesthesiology, Hôpital Laennec, ParisFrance
  3. 3.Department of Medicine, Monash Medical Centre, MelbourneAustralia

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