A phase II randomized, controlled trial of continuous hemofiltration in sepsis

Abstract

Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

Prevention and Treatment of Acute Renal Failure in Sepsis

“…It should be noted that the reduction in body temperature was larger during HVHF, although not to a significant extent (134). In a randomized trial of 24 patients with septic shock without renal dysfunction, early start of CVVH at an ultrafiltration rate of 2 L/h failed to affect the plasma concentrations of inflammatory mediators or any clinical outcome parameter (135). Combined use of a superflux hemofilter and ultrafiltration rates of 6 L/h was found to achieve high cytokines clearances in addition to a substantial loss of albumin (136).…”

Clinical review: Blood purification for sepsis

“…Unlike HVHF, standard 'renal dose' continuous renal replacement therapy (CRRT) appears to be in effective as an immune modulating therapy. Like Cole and colleagues [36] in 2002, Payen and colleagues [37] found no difference (and even a trend toward worse outcomes) between septic shock patients who did not have acute kidney injury and who underwent CVVH (25 mL/kg per hour for a 96-hour period) at the early phase of sepsis and those who were managed conventionally.…”

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

“…It is widely accepted that the release of large amounts of pro-and anti-inflammatory mediators that occurs in severe sepsis contributes to the development of multiple organ dysfunction syndrome (MODS) (8,(58)(59)(60), including ARF. Theoretically, high-dose CRRT could remove mediators by convection and/or adsorption (44,61) and reduce mortality, even in the absence of ARF (62).…”

“…Current therapeutic strategies against sepsis are still based on the pharmacology of the immunoinflammatory cascade, however so far very few studies in stage III and IV with these "pro-sepsis" drugs who have achieved favorable results in improving the survival of patients. For this reason the hypothesis that CRRT may modulate this broad and inappropriate tissue inflammation by eliminating inflammatory mediators remains highly attractive (8,9). …”