Treatment of septic shock with continuous HDF using 2 PMMA hemofilters for enhanced intensity.

Abstract

PURPOSE:

Cytokines play pivotal roles in the pathophysiology of severe sepsis/septic shock, and continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) removes cytokines efficiently and continuously, mainly through adsorption to a hemofilter membrane. The aim of this study was to investigate the clinical efficacy of enhanced intensity PMMA-CHDF in treating refractory septic shock.

METHODS:

Seventy-two septic shock patients admitted to the intensive care unit (ICU) underwent critical care including PMMA-CHDF. We employed enhanced intensity PMMA-CHDF to improve the cytokine removal rate by increasing the hemofilter membrane area in 10 refractory septic shock patients (enhanced intensity group, EI group; 2 extracorporeal CHDF circuits using the hemofilter with a larger membrane area of 2.1 m2). Other patients undergoing conventional PMMA-CHDF and matched for severity with the EI group, comprised a matched conventional group (MC group; using a PMMA membrane hemofilter with a membrane area of 1.0 m2; n=15). The case-control comparison was performed between the 2 groups.

RESULTS:

Enhanced intensity PMMA-CHDF significantly increased mean arterial pressure by 23.8% in 1 hour (p=0.037), decreased the blood lactate level by 28.6% in 12 hours (p=0.006), and reduced blood IL-6 level in 24 hours (p=0.005). The ICU survival rate in the EI group was significantly better than that in the MC group (60% vs. 13.3%, p=0.028).

CONCLUSION:

Enhanced intensity PMMA-CHDF may improve hemodynamics and survival rate in patients with refractory septic shock.

• Authors: Yosuke Matsumura, Shigeto Oda, Tomohito Sadahiro, Masataka Nakamura, Yo Hirayama, Eizo Watanabe, Ryuzo Abe, Taka-Aki Nakada, Yoshihisa Tateishi, Taku Oshima, Koichiro Shinozaki, Hiroyuki Hirasawa
• Journal: The International journal of artificial organs (Int J Artif Organs) Vol. 35 Issue 1 Pg. 3-14 (Jan 2012) ISSN: 1724-6040 [Electronic] United States
• PMID: 22287204 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• IL6 protein, human
• Interleukin-6
• Membranes, Artificial
• Lactic Acid
• Polymethyl Methacrylate

Topics

• Adult
• Aged
• Biomarkers (blood)
• Blood Pressure
• Critical Care
• Equipment Design
• Female
• Hemodiafiltration (adverse effects, instrumentation, mortality)
• Humans
• Intensive Care Units
• Interleukin-6 (blood)
• Japan
• Lactic Acid (blood)
• Male
• Membranes, Artificial
• Middle Aged
• Polymethyl Methacrylate
• Retrospective Studies
• Shock, Septic (blood, mortality, physiopathology, therapy)
• Survival Analysis
• Survival Rate
• Time Factors
• Treatment Outcome
• Young Adult