The impacts of continuous veno-venous hemofiltration on plasma cytokines and monocyte human leukocyte antigen-DR expression in septic patients

Zhang, Peng; Peng, Pai; Liu, Hongbao; Li, Rong; Wang, Hanmin; Huang, Chen

doi:10.1016/j.cyto.2010.02.005

Cited by 41 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several nonrandomized clinical and animal studies have shown a benefit [2]. The rationale for this treatment is that within the setting of an overwhelming inflammatory response, pro-and antiinflammatory mediators can be removed [3] and homeostasis restored [4]. Grootendorst et al [5] had already found that substance removal by hemofiltration likely plays a role, because the infusion of ultrafiltrate from endotoxemic pigs depresses myocardial performance in normal pigs, while the infusion of ultrafiltrate from healthy pigs does not.…”

mentioning

confidence: 99%

How to explain and exploit the beneficial effects of high-volume hemofiltration on hemodynamics and strong ion gap

Straaten

Elbers

2013

Intensive Care Med

View full text Add to dashboard Cite

Early high-volume hemofiltration has been suggested as adjuvant treatment for critically ill patients with severe septic shock to stabilize the circulation [1]. Several nonrandomized clinical and animal studies have shown a benefit [2]. The rationale for this treatment is that within the setting of an overwhelming inflammatory response, pro-and antiinflammatory mediators can be removed [3] and homeostasis restored [4]. Grootendorst et al. [5] had already found that substance removal by hemofiltration likely plays a role, because the infusion of ultrafiltrate from endotoxemic pigs depresses myocardial performance in normal pigs, while the infusion of ultrafiltrate from healthy pigs does not. However, a recent meta-analysis including randomized controlled trials and subgroups from randomized controlled trials was not able to show any benefit of continuous renal replacement therapy (CRRT) versus no CRRT or a higher dose of CRRT in patients with severe sepsis or septic shock in terms of survival, hemodynamics, pulmonary gas exchange, organ failure and length of stay [6]. The effect of CRRT on survival was not modified by CRRT dose. This was recently confirmed by a large randomized controlled trial [7].Bellomo et al. [8] now specifically report on data from this trial from a nested cohort of 115 patients from two of the participating ICUs. Patients were treated with venovenous hemodiafiltration of either low intensity (with effluent flow at 25 ml/kg/h) or high intensity (at 40 ml/kg/ h). They focused on the control of metabolic acidosis, mean arterial blood pressure and noradrenaline dose and their relationship during the first 24 h of treatment. They found that pH and traditional markers of the metabolic component of acid base balance, i.e. bicarbonate and base excess similarly improved in both groups. However, in the high-intensity arm, lactate and in particular the strong ion gap (SIG) decreased significantly, concomitantly with an increase in mean arterial blood pressure and a decreased noradrenaline dose. These improvements were not observed in the low-intensity arm.These results may be of clinical importance. But how do we explain and more importantly how do we exploit them? Substance removal and reversal of hypotensionHigh-intensity CRRT likely removes more inflammatory mediators than the low-intensity modality. However, the removal of cytokines is often not sufficient to decrease plasma concentrations [9]. The reasons may be the high size and low free fraction of the cytokines, and the higher rate of production compared to removal. In contrast, freecirculating mediators in the middle molecular range, such as complement factors [1], prostaglandins and leukotrienes [10], and myocardial depressant factors [11] are removed [12,13].In the present study, SIG significantly decreased in the high-intensity group, which was not the case in the lowintensity group. This may indicate that substance removal contributed to improved hemodynamics. In this setting, SIG likely represents unmeasured strong anions.

show abstract

mentioning

confidence: 99%

How to explain and exploit the beneficial effects of high-volume hemofiltration on hemodynamics and strong ion gap

Straaten

Elbers

2013

Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…12,21 Peng et al showed lowering of cytokine levels at high level of CVVH. 10 The principle should be that the 'intensity' should be adequate enough to flash out cytokines at a rate higher than the rate of production. There are literatures showing the changing levels of cytokines at sequential assessment.…”

Section: The Intensity Of Crrtmentioning

confidence: 99%

“…Cornejo et al 21 have shown that in refractory septic shock, reversal of shock needed much higher rate of hemofiltration. Conversely, Peng et al 10 showed that hemofiltration at high rate (70 mL/kg/hr) lowered the levels of multiple cytokines, but they did not show the mortality outcome.…”

mentioning

confidence: 99%

“…[7][8][9] There has been report of lowering of level of cytokines if convection is applied with higher intensity. 10 Also, Simmons et al showed that those who died of ARF had much higher cytokine levels. 11 So the use of convection is likely to be of better outcome.…”

mentioning

confidence: 99%

“…The rate of removal of cytokines depends on the strength of hemofiltration. 10 One issue has not been well-addressed -the intensity of production of inflammatory mediators and the rate of its removal. As the rate of production of mediators is self-limiting, when it will stop or when the intensity of production will fall below a critical level is not known.…”

mentioning

confidence: 99%

See 2 more Smart Citations