High-volume haemofiltration in human septic shock

Cole, Louise; Bellomo, Rinaldo; Journois, Didier; Davenport, Piers; Baldwin, Ian; Tipping, Peter G.

doi:10.1007/s001340100963

Cited by 308 publications

(202 citation statements)

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“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

Section: Discussionsupporting

confidence: 87%

“…It should be noted, however, that in the Rogiers study the body temperature fell below baseline with the lowest value of 36.1°C, which is in marked contrast to our results. Alternatively, cutting the plasma peak concentrations of cytokines [37] without a measurable effect on plasma cytokines levels or elimination of other unmeasured vasodilatory or inflammatory mediators [9,[38][39][40] could have explained the observed systemic hemodynamic effects of haemofiltration. Finally, removal of sedative drugs leading to an increased sympathetic drive of animals cannot be completely excluded.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Ronco et al [5] suggested a beneficial trend in survival when further increasing the dose of haemofiltration up to 45 ml/kg per hour in a small subgroup of septic patients. Although limited in their robustness and methodological aspects, several human [9][10][11][12][13][14][15] and animal [16][17][18][19][20] studies further support the concept of high-volume haemofiltration (HVHF) in the treatment of endotoxemia or septic shock, mainly by demonstrating a reduced need for vasopressors dose and better hemodynamic stability. However, human studies were either uncontrolled or retrospective, thereby limiting the inference that could be drawn [21].…”

Section: Introductionmentioning

confidence: 99%

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High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

et al. 2008

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Objective: The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration (HVHF) in a peritonitis-induced model of porcine septic shock. Design and setting: Randomized, controlled experimental study. Subjects: Twenty-one anesthetized and mechanically ventilated pigs. Interventions: After 12 h of hyperdynamic peritonitis, animals were randomized to receive either supportive treatment (Control, n = 7) or standard haemofiltration (HF 35 ml/ kg per h, n = 7) or HVHF (100 ml/kg per hour, n = 7). Measurements and results: Systemic and hepatosplanchnic haemodynamics, oxygen exchange, energy metabolism (lactate/pyruvate, ketone body ratios), ileal and renal cortex microcirculation and systemic inflammation (TNF-a, IL-6), nitrosative/oxidative stress (TBARS, nitrates, GSH/GSSG) and endothelial/coagulation dysfunction (von Willebrand factor, asymmetric dimethylarginine, platelet count) were assessed before, 12, 18, and 22 h of peritonitis. Although fewer haemofiltration-treated animals required noradrenaline support (86, 43 and 29% animals in the control, HF and HVHF groups, respectively), neither of haemofiltration doses reversed hyperdynamic circulation, lung dysfunction and ameliorated alterations in gut and kidney microvascular perfusion. Both HF and HVHF failed to attenuate sepsisinduced alterations in surrogate markers of cellular energetics, nitrosative/oxidative stress, endothelial injury or systemic inflammation. Conclusions: In this porcine model of septic shock early HVHF proved superior in preventing the development of septic hypotension. However, neither of haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function, at least within the timeframe of the study and severity of the model.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

et al. 2008

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“…In a randomized cross-over study of 11 patients with septic shock and multi-organ failure, an 8-hour period of HVHF (6 L/hour) was associated with a greater reduction in norepinephrine requirements in comparison with a similar period of CVVH (1 L/hour) [26]. Reduction of vasopressor requirements with HVHF was also found more recently in a pilot randomized study comparing CVVH at 65 mL/kg per hour versus 35 mL/kg per hour in 20 septic shock patients with acute kidney injury [27].…”

Section: High-volume Hemofiltrationmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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“…The most spectacular indication is early isovolemic hemofiltration in patients who have septic shock (45,46). Most of the still uncontrolled and preliminary studies describing this dialysis modality only use outcomes on "crude mortality" and surrogate end points, such as need for vasopressors (47,48). One retrospective study (49) compared two groups of oliguric septic patients (before and after introduction of early short-term isovolemic hemofiltration).…”

Section: Defining Kidney Failurementioning

confidence: 99%

Defining Acute Renal Failure

Biesen

Vanholder²,

Lameire³

2006

Clinical Journal of the American Society of Nephrology

153

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The introduction of the RIFLE classification has increased the conceptual understanding of the acute kidney injury (AKI) syndrome, and this classification has been successfully tested in a number of clinical studies. This review discusses the strengths and weaknesses of the RIFLE classification and suggests additional parameters to broaden future definitions of AKI. These definitions should not only focus on kidney function alone, but also include parameters describing the origin of the patient, the most important causal factors responsible for AKI and information on the pre-existing kidney function. This more complete definition should lead to a decrease in the variability of the results of epidemiological studies and of future clinical trials in AKI populations.

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High-volume haemofiltration in human septic shock

Abstract: HVHF decreases vasopressor requirements in human septic shock and affects anaphylatoxin levels differently than standard CVVH.

Cited by 308 publications

References 0 publications

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

Clinical review: Blood purification for sepsis

Defining Acute Renal Failure

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