High-volume haemofiltration for sepsis in adults

Borthwick, Emma; Hill, Christopher J.; Rabindranath, Kannaiyan S; Maxwell, Alexander P.; McAuley, Daniel F.; Blackwood, Bronagh

doi:10.1002/14651858.cd008075.pub3

Cited by 68 publications

(58 citation statements)

References 48 publications

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“…Whereas some studies found an improvement of hemodynamic parameters and a lower than expected mortality [23][24][25][26], the IVOIRE (high volume in intensive care) RCT failed to find a significant difference in mortality between the high-volume group (70 mL·kg -1 ·h -1 ) and the standard volume group (35 mL·kg -1 ·h -1 ), but also it could not find an improvement in secondary outcomes such as hemodynamic parameters, severity scores and length of stay [27]. This absence of beneficial effects was confirmed by 2 recent meta-analyses [28,29].…”

Section: Removing Cytokinesmentioning

confidence: 98%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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Section: Removing Cytokinesmentioning

confidence: 98%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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“…Recently, CRRT, as an effective adjuvant therapy, is proved to improve the survival of patients with severe sepsis. HVFH was an efficacious choice in removing the inflammatory mediators and improving clinical outcome in adult patients with sepsis [35]. However, no clear evidence has been emerged for the benefits of HVFH on the severe sepsis treatment in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Animal experiments indicated that high-volume hemofiltration (HVHF), as a model of the CRRT techniques, improves hemodynamic recovery through removing soluble inflammatory mediators [16,17,18,19]. Moreover, HVHF is considered as an effective management to improve outcomes of patients with severe sepsis [20,21,22,23]. As it was noted previously, HVHF could maintain acid-base, azotemic, and fluid balances and also had the potential to modulate the immune system body response to sepsis [23,24].…”

Section: Introductionmentioning

confidence: 99%

Clinical Benefits of High-Volume Hemofiltration in Critically Ill Pediatric Patients with Severe Sepsis: A Retrospective Cohort Study

et al. 2017

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Aims: The study aimed to assess the clinical benefits of high-volume hemofiltration (HVHF) in pediatric patients with severe sepsis compared with standard-volume continuous veno-venous hemofiltration (CVVH). Methods: We retrospectively analyzed the medical records of 155 pediatric patients with severe sepsis admitted to the pediatric intensive care unit of Shanghai Children's Hospital from January 2010 to June 2016. A total of 93 patients were treated with HVHF and 62 patients were treated with CVVH. Results: HVHF treatment did not significantly reduce 28-day mortality. Moreover, there was no significant difference in reducing the plasma level of inflammatory mediators and improving hemodynamic variables between HVHF and CVVH group. However, the incidence of hyperglycemia was significantly higher in HVHF group than in CVVH group. Conclusions: There is no evidence to indicate that HVHF is superior to CVVH in reducing 28-day mortality as an adjunct to the treatment of severe sepsis in pediatric patients.

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“…A Cochrane review published in 2017 concluded: no clear evidence showed any benefit of high volume haemofiltration in critically ill patients with severe sepsis or septic shock [47]. The failure of renal replacement to improve mortality in sepsis, and the absence of cellular injury in renal failure, suggests that the decrease in glomerular filtration rate in sepsis may be a regulated trait, not a dysregulated one.…”

Section: Organ Failurementioning

confidence: 99%

The Emperor Has no Clothes? Searching for Dysregulation in Sepsis

Alcock

2018

Preprint

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The core conception of sepsis -that it is a dysregulated state -is a powerful and durable ideathat has inspired decades of research into sepsis. But is it true that the body's response to sepsis is dysregulated? To answer that question, this review surveyed the history of trials of agents targeting the host response. Sepsis survival is not improved by blocking one or many immune pathways. Similarly, sepsis is resistant to treatment by normalizing one or many physiologic parameters simultaneously. The vast majority of interventions are either ineffective or harmful.With this track record of failure, it is time to consider the null hypothesis -regulation instead of dysregulation -and possibility that sepsis traits are often functional, and do more harm than good. This review discusses the implications of this perspective for the future of sepsis research.

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High-volume haemofiltration for sepsis in adults

Abstract: High-volume haemofiltration for sepsis in adults.

Cited by 68 publications

References 48 publications

Extracorporeal Blood Purification Therapies for Sepsis

Extracorporeal Blood Purification Therapies for Sepsis

Clinical Benefits of High-Volume Hemofiltration in Critically Ill Pediatric Patients with Severe Sepsis: A Retrospective Cohort Study

The Emperor Has no Clothes? Searching for Dysregulation in Sepsis

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