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

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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.

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References

  1. Murray P, Hall J (2000) Renal replacement therapy for acute renal failure. Am J Respir Crit Care Med 162:777–881

    PubMed  CAS  Google Scholar 

  2. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818

    Article  PubMed  CAS  Google Scholar 

  3. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058

    Article  PubMed  Google Scholar 

  4. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356:26–30

    Article  PubMed  CAS  Google Scholar 

  5. Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310

    Article  PubMed  Google Scholar 

  6. Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR (2000) Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 28:3581–3587

    Article  PubMed  CAS  Google Scholar 

  7. Joannes-Boyau O, Rapaport S, Bazin R, Fleureau C, Janvier G (2004) Impact of high volume hemofiltration on hemodynamic disturbance and outcome during septic shock. ASAIO J 50:102–109

    Article  PubMed  Google Scholar 

  8. Oudemans-Van Straaten HM, Bosman RJ, van der Spoel JI, Zandstra DF (1999) Outcome of critically ill patients treated with intermittent high-volume hemofiltration: a prospective cohort analysis. Intensive Care Med 25:814–821

    Article  PubMed  CAS  Google Scholar 

  9. Cole L, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P (2001) High-volume hemofiltration in human septic shock. Intensive Care Med 27:978–986

    Article  PubMed  CAS  Google Scholar 

  10. Cornejo R, Downey P, Castro C, Romero C, Regueira T, Vega J, Castillo N, Andresen M, Dougnac A, Bugedo G, Hernandez G (2006) High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock. Intensive Care Med 32:713–722

    Article  PubMed  CAS  Google Scholar 

  11. Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D’Intini V, Tetta C, Bellomo R, Ronco C (2006) Early isovolaemic hemofiltration in oliguric patients with septic shock. Intensive Care Med 32:80–86

    Article  PubMed  CAS  Google Scholar 

  12. Cariou A, Vinsonneau C, Dhainaut JF (2004) Adjunctive therapies in sepsis: an evidence-based review. Crit Care Med 32:S562–S570

    Article  PubMed  Google Scholar 

  13. Bellomo R, Ronco C (1998) Indications and criteria for initiating renal replacement therapy in the intensive care unit. Kidney Int 66:S106–S109

    CAS  Google Scholar 

  14. Lameire N, Van Biesen W, Vanholder R (2005) Acute renal failure. Lancet 365:417–430

    PubMed  CAS  Google Scholar 

  15. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138

    PubMed  CAS  Google Scholar 

  16. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med 34:17–60

    Article  PubMed  Google Scholar 

  17. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  CAS  Google Scholar 

  18. Larvin M, McMahon MJ (1989) APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 2:201–205

    Article  PubMed  CAS  Google Scholar 

  19. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810

    Article  PubMed  CAS  Google Scholar 

  20. Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1989) Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med 17:389–393

    Article  PubMed  CAS  Google Scholar 

  21. Stein B, Pfenninger E, Grunert A, Schmitz JE, Hudde M (1990) Influence of continuous haemofiltration on haemodynamics and central blood volume in experimental endotoxic shock. Intensive Care Med 16:494–499

    Article  PubMed  CAS  Google Scholar 

  22. Gomez A, Wang R, Unruh H, Light RB, Bose D, Chau T, Correa E, Mink S (1990) Hemofiltration reverses left ventricular dysfunction during sepsis in dogs. Anesthesiology 73:671–685

    Article  PubMed  CAS  Google Scholar 

  23. Bellomo R, Kellum JA, Gandhi CR, Pinsky MR, Ondulik B (2000) The effect of intensive plasma water exchange by hemofiltration on hemodynamics and soluble mediators in canine endotoxemia. Am J Respir Crit Care Med 161:1429–1436

    PubMed  CAS  Google Scholar 

  24. Grootendorst AF, van Bommel EF, van der Hoven B, van Leengoed LA, van Osta AL (1992) High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig. Intensive Care Med 18:235–240

    Article  PubMed  CAS  Google Scholar 

  25. Martin-Malo A, Carracedo J, Ramirez R, Rodriguez-Benot A, Soriano S, Rodriguez M, Aljama P (2000) Effect of uremia and dialysis modality on mononuclear cell apoptosis. J Am Soc Nephrol 11:936–942

    PubMed  CAS  Google Scholar 

  26. Haag-Weber M, Horl WH (1993) Uremia and infection: mechanisms of impaired cellular host defense. Nephron 63:125–131

    Article  PubMed  CAS  Google Scholar 

  27. Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, Ronco C (2002) A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit Care Med 30:100–106

    Article  PubMed  CAS  Google Scholar 

  28. Bellomo R, Ronco C (2001) The renal effets of noradrenaline and dopamine. Contrib Nephrol 132:146–157

    Article  PubMed  CAS  Google Scholar 

  29. Di Giantomasso D, Morimatsu H, May C, Bellomo R (2003) Intrarenal blood flow distribution in hyperdynamic septic shock: effects of norepinephrine. Crit Care Med 31:2509–2513

    Article  PubMed  CAS  Google Scholar 

  30. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, the ADQI workgroup (2004) Acute renal failure––definition, outcome measures, animal models, fluid therapy and information needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212

    Google Scholar 

  31. Ratanarat R, Brendolan A, Piccinni P, Dan M, Salvatory G, Ricci Z, Ronco C (2005) Pulse high-volume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival. Crit Care 9:294–302

    Article  Google Scholar 

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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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Authors and Affiliations

  1. Intensive Care and Infectious Disease Unit, Tourcoing Hospital, 135, rue du Président Coty, BP 619, 59208, Tourcoing cedex, France

    Nicolas Boussekey

  2. Intensive Care and Infectious Disease Unit, Tourcoing Hospital, University of Lille II, Lille, France

    Arnaud Chiche, Thibaud d’Escrivan, Hugues Georges & Olivier Leroy

  3. Department of Biostatistics, University of Lille II, Lille, France

    Patrick Devos

  4. Infectious Diseases Unit, CHRU Lille, University of Lille II, Lille, France

    Karine Faure & Benoit Guery

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  1. Nicolas Boussekey
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  2. Arnaud Chiche
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Correspondence to Nicolas Boussekey.

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Boussekey, N., Chiche, A., Faure, K. et al. A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock. Intensive Care Med 34, 1646–1653 (2008). https://doi.org/10.1007/s00134-008-1127-3

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  • DOI: https://doi.org/10.1007/s00134-008-1127-3

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