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Very high volume hemofiltration with the Cascade system in septic shock patients

Abstract

Purpose

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.

Conclusion

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.

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Acknowledgments

We thank all the following contributors to the study: Dijon University Hospital (Elisabeth Cornot and Thérèse Devaux as well as the nursing team); Clermont-Ferrand University Hospital (Mireille Adda and the nursing team); Melun Hospital (Cécile Lormail and the nursing team); and the Gambro study team (Nicolas Semenzato, Nathalie Loughraieb and Hiram Rada). The authors also thank Fiona Ecarnot (EA3920, University Hospital Besancon, France) for translation and editorial assistance.

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Correspondence to Jean-Pierre Quenot.

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The authors of this paper have no conflicts of interest to report.

Funding

This study was sponsored by Gambro Industries, Meyzieu, France.

Additional information

For the Cascade study group.

Take-home message: Very high volume hemofiltration using the Cascade system can safely be used in patients presenting with septic shock, but it is not associated with a reduction in the need for catecholamines during the first 28 days.

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Quenot, JP., Binquet, C., Vinsonneau, C. et al. Very high volume hemofiltration with the Cascade system in septic shock patients. Intensive Care Med 41, 2111–2120 (2015). https://doi.org/10.1007/s00134-015-4056-y

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Keywords

  • Septic shock
  • Hemofiltration
  • Cytokines
  • Amino acids