Treatment of septic shock with continuous HDF using 2 PMMA hemofilters for enhanced intensity.
Int J Artif Organs
; 35(1): 3-14, 2012 Jan.
Article
em En
| MEDLINE
| ID: mdl-22287204
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Hemodiafiltração
/
Polimetil Metacrilato
/
Membranas Artificiais
Tipo de estudo:
Observational_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Asia
Idioma:
En
Revista:
Int J Artif Organs
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Japão