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

Honoré, Patrick M.; Jamez, J.; Wauthier, Michel; Lee, Patrice A.; Dugernier, Thierry; Pirenne, B.; Hanique, G.; Matson, James R.

doi:10.1097/00003246-200011000-00001

Cited by 388 publications

(264 citation statements)

References 37 publications

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“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

Section: Discussionsupporting

confidence: 90%

“…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: 90%

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…In an analysis of retrospective data from the Cleveland Clinic Foundation registry, it was suggested that, in ICU patients with AKI, survival is improved for those who receive a higher dosage of intermittent RRT or continuous RRT (CRRT) in comparison with those who receive a lower dosage (17). Honore et al (18) showed that short-term, high-volume hemofiltration was well tolerated and improved survival in patients with septic shock. However, in another study of such patients, no association was found between dialysis dosage and survival (19).…”

Section: Discussionmentioning

confidence: 99%

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Andrade

Cleto

Seguro

2007

Clinical Journal of the American Society of Nephrology

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Background: Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage.Design, setting, participants, and measurements: It is logical to assume that increasing the dialysis dosage would minimize uremic complications and improve outcomes in such patients. Patients with Weil's disease constitute a homogeneous population and are typically free of comorbidities, therefore presenting an ideal model in which to test this assumption.Results Conclusions: On the basis of this result, it is believed that alternate-day hemodialysis is no longer appropriate for critically ill patients with Weil's disease.

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“…Though uncontrolled, at least six studies have found significant (and sometimes spectacular) reductions in mortality rate with HVHF compared with predicted mortality [28-33]. Honoré and colleagues [29] reported a reduction of the mortality rate from 79% (expected mortality based on APACHE II [Acute Physiology and Chronic Health Evaluation II] score and SAPS II [Simplified Acute Physiology Score II]) to 55%. Several years later, Joannes-Boyau and colleagues [30] obtained a similar result with a predicted 28-day mortality of 70% and an observed mortality of 46% in a study assessing the effect of 40 to 60 mL/kg per hour maintained for 96 hours in patients with septic shock.…”

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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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

Abstract: These data suggest that STHVH may be of major therapeutic value in the treatment of intractable cardiocirculatory failure complicating septic shock. Early initiation of therapy and adequate dose may improve hemodynamic and metabolic responses and 28-day survival.

Cited by 388 publications

References 37 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?

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Clinical review: Blood purification for sepsis

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