In-line filtration minimizes organ dysfunction: New aspects from a prospective, randomized, controlled trial

Abstract

BackgroundInfused particles induce thrombogenesis, impair microcirculation and modulate immune response. We have previously shown in critically ill children, that particle-retentive in-line filtration reduced the overall complication rate of severe events, length of stay and duration of mechanical ventilation. We now evaluated the influence of in-line filtration on different organ function and thereby elucidated the potential underlying pathophysiological effects of particle infusion.MethodsIn this single-centre, prospective, randomized controlled trial 807 critically ill children were assigned to either control (n = 406) or filter group (n = 401), the latter receiving in-line filtration for complete infusion therapy. Both groups were compared regarding the differences of incidence rates and its 95% confidence interval (CI) of different organ dysfunction as defined by the International Pediatric Sepsis Consensus Conference 2005.ResultsThe incidence rates of respiratory (−5.06%; 95% CI, −9.52 to −0.59%), renal (−3.87%; 95% CI, −7.58 to −0.15%) and hematologic (−3.89%; 95% CI, −7.26 to −0.51%) dysfunction were decreased in the filter group. No difference was demonstrated for the occurrence rates of cardiovascular, hepatic, or neurologic dysfunction between both groups.ConclusionsIn-line filtration has beneficial effects on the preservation of hematologic, renal and respiratory function in critically ill patients. The presented clinical data further support our hypothesis regarding potential harmful effects of particles. In critically ill patients infused particles may lead to further deterioration of the microcirculation, induce a systemic hypercoagulability and inflammation with consecutive negative effects on organ function.Trial registrationClinicalTrials.gov number; NCT00209768

Avoid Drug Incompatibilities: Clinical Context in Neonatal Intensive Care Unit (NICU)

“…Their study demonstrate potential beneficial effects of in-line filtration on the preservation of various organ systems, even if further experimental and clinical investigations are necessary to clarify the exact impact of infused particles [36].…”

“…The SIRS is related to the particle administration during infusion, and has already been well demonstrated for adult patients of intensive care units [22], and more recently in the pediatric population [36].…”

“…hypothesis was that infused particles act directly on the microcirculation of several organ systems such as the kidney and lung and induce a systemic hypercoagulability and inflammation [36].…”

Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients

“…These authors also showed that particulate contamination could be present downstream from the in-line filter, with particles greater than 10 µm. Nevertheless, the benefits of these filters have been challenged by several authors [3,67,68]. A meta-analysis did not provide specific justification for using in-line IV filters to prevent morbidity and mortality [69] and there may be a problem in clinical practices due to the ineffectiveness of the therapeutic management.…”

“…Recently, studies have investigated the impact of particulate contamination on organ failure in critically ill children. Boehne et al [68] evaluated the clinical impact of particulate contamination on different organs, as defined by the International Pediatric Sepsis Conference 2005 [109]. They concluded that the infusion of particles may cause alteration to the microcirculation, inducing systemic inflammatory reactions with adverse effects on organs.…”