In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial

Abstract

PurposeParticulate contamination due to infusion therapy carries a potential health risk for intensive care patients.MethodsThis single-centre, prospective, randomized controlled trial assessed the effects of filtration of intravenous fluids on the reduction of complications in critically ill children admitted to a pediatric intensive care unit (PICU). A total of 807 subjects were randomly assigned to either a control (n = 406) or filter group (n = 401), with the latter receiving in-line filtration. The primary endpoint was reduction in the rate of overall complications, which included the occurrence of systemic inflammatory response syndrome (SIRS), sepsis, organ failure (circulation, lung, liver, kidney) and thrombosis. Secondary objectives were a reduction in the length of stay on the PICU and overall hospital stay. Duration of mechanical ventilation and mortality were also analyzed.FindingsAnalysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group. In particular, the incidence of SIRS was significantly lower (n = 123 [30.3 %] vs. n = 90 [22.4 %]; P = 0.01). Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97−4.82] vs. 2.98 [2.33−3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6−22.4] vs. 11.0 [7.1−14.9] h; P = 0.028) were significantly reduced.ConclusionIn-line filtration is able to avert severe complications in critically ill patients. The overall complication rate during the PICU stay among the filter group was significantly reduced. In-line filtration was effective in reducing the occurrence of SIRS. We therefore conclude that in-line filtration improves the safety of intensive care therapy and represents a preventive strategy that results in a significant reduction of the length of stay in the PICU and duration of mechanical ventilation (ClinicalTrials.gov number: NCT00209768).Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-012-2539-7) contains supplementary material, which is available to authorized users.

Avoid Drug Incompatibilities: Clinical Context in Neonatal Intensive Care Unit (NICU)

“…These particles can come directly from the preparation (glass or rubber fragments) or be linked to the existence of drug incompatibilities in the context of a multi-infusion [20]. The administration of these particles can have serious consequences for the patient, as endothelial lesions and thrombosis [21,22], and the use of inline filters has been shown to reduce the number of general complications and Systemic Inflammatory Response Syndrome (SIRS) [23]. However, a recent meta-analysis did not reveal a significant effect of online filters on overall mortality in pediatrics/neonatology [24].…”

Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients

“…These authors also showed that particulate contamination could be present downstream from the in-line filter, with particles greater than 10 µm. Nevertheless, the benefits of these filters have been challenged by several authors [3,67,68]. A meta-analysis did not provide specific justification for using in-line IV filters to prevent morbidity and mortality [69] and there may be a problem in clinical practices due to the ineffectiveness of the therapeutic management.…”

“…Jack et al [3] designed a prospective study with more than 800 children who were randomly assigned to two groups (with and without in-line filters). This study showed that the occurrence of SIRS was reduced when using 0.22 µm and/or 1.2 µm in-line filters.…”

“…Particulate matter in injections can be a serious health problem with potentially severe consequences for patients, especially if particles are infused in a precipitate. Such consequences may include CVC obstruction, occurrence of potentially fatal embolism [1], deposits of calcium phosphate crystals in various organs during total parenteral nutrition [2] or systemic inflammatory response syndromes (SIRS) [3]. The United States Pharmacopoeia (USP) defines injectable drug particulate matter as "foreign particles, undissolved, mobile, other than gas bubbles, which are involuntary in these solutions (parenteral formulations)" [4].…”

Cessation of In-line Filters in Central Venous Catheters Does Not Significantly Influence the Incidence of Bloodstream Infections and Mortality in a Hospital Hematological Ward

“…In particular, the administration of particles through infusion solutions can sometimes result in adverse effects, such as physical occlusion, inflammatory responses, neoplastic responses, and antigenic responses (1). Some reports on pediatric care units have described that in-line filters reduce the overall complication rate and length of stay on pediatric care unit (2); in addition, they also reduce respiratory, renal, and hematological dysfunctions (3) and thrombus formation (4) by preventing particle infusion. In several reviews and guidelines, in-line filters are recommended solely for immunosuppressed patients, newborns, and children (1,5).…”