Application of early continuous renal replacement therapy in the bundle treatment of severe pneumonia / 中华危重病急救医学

ABSTRACT

Objective To explore the role of early continuous renal replacement therapy (CRRT) in bundle treatment of severe pneumonia. Methods Seventy severe pneumonia patients admitted to respiratory intensive care unit (RICU) of Second Affiliated Hospital of Xuzhou Medical University from January 2013 to June 2017 were enrolled. The patients were randomly divided into routine treatment group and CRRT treatment group, with 35 patients in each group. All patients were treated with bundle therapy, and those in CRRT treatment group was treated with CRRT daily on the basis of conventional bundle therapy. The mode was continuous veno-venous hemofiltration (CVVH), lasting 8-24 hours at a time. On the day of admission and the treatment of 1, 3, 5, 7 days, the fasting venous blood was collected. Inflammatory stress and immune parameters including procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and CD4+cells were determined by enzyme linked immunosorbent assay (ELISA) or flow cytometer. The incidence of acute respiratory distress syndrome (ARDS) and mortality within 7 days were observed in the two groups. Results Seventy patients with severe pneumonia were enrolled. There was no significant difference in the serum PCT, IL-6, TNF-α or CD4+before treatment between the two groups. With the prolongation of treatment time, the PCT, IL-6 and TNF-α levels were gradually decreased, and the CD4+was gradually increased. Compared with routine treatment group, PCT and TNF-α in CRRT treatment group were significantly decreased since the 3rd day [PCT (μg/L): 3.11±1.28 vs. 3.76±1.42, TNF-α (ng/L): 98.61±11.58 vs. 119.47±12.38], and CD4+was significantly increased (0.39±0.03 vs. 0.35±0.03, all P < 0.05). The changes in IL-6 of CRRT treatment group was delayed, the statistical significance was found since the 5th day as compared with routine treatment group (ng/L: 35.43±12.39 vs. 52.86±10.78, P < 0.05). Compared with routine treatment group, the incidence of ARDS [11.43% (4/35) vs. 31.43% (11/35)] and mortality [0% (0/35) vs. 11.43% (4/35)] within 7 days in CRRT treatment group were significantly lowered (both P < 0.05). Conclusions CRRT in the early stage of bundle therapy for severe pneumonia is not only suggested to remove inflammatory mediators and improve immune function, but an opportunity and effective way to reduce complications and delay rapid progression of severe pneumonia. It provides the opportunity and condition for comprehensive treatment.