A phase II randomized, controlled trial of continuous hemofiltration in sepsis
A phase II randomized, controlled trial of continuous hemofiltration in sepsis
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DOI：
10.1097/00003246-200201000-00016
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发表时间：
2002-01-01
影响因子：
8.8
通讯作者：
Ronco, C
中科院分区：
文献类型：
--
作者：
Cole, L;Bellomo, R;Ronco, C
目的：研究早期和持续静脉-静脉血液滤过(CVVH)对脓毒症患者几种炎症体液介质和随后的器官功能障碍的影响。设计：随机对照试验。地点：三级医院重症监护室。患者：24例早期感染性休克或感染性器官功能障碍患者。干预：随机分配接受48小时等容CVVH，换液速度为2 L/小时或不进行血液滤过。测量和主要结果：我们测量了血浆补体C3a和C5a，白介素6，8，10和肿瘤坏死因子a，在基线和2，24，26，48，48小时的浓度72小时。每天计算每个患者的多器官功能障碍评分(MODS)，直到死亡或从重症监护病房出院。大多数介质的浓度在基线至72小时之间下降。在特定的时间点之间可以发现一些显著的浓度下降，但CVVH与任何血浆细胞因子浓度的总体下降无关。对照组存活者的平均累积MODS(43.3+/-19.7)与CVVH存活者的平均累积MODS(33.2+/-19.0；p=.30)之间也没有差异，所有对照组(4.1+/-1.9)与所有CVVH受试者(3.3+/-1.7；p=.26)计算的平均MODS之间也没有差异。结论：早期应用2 L/小时的CVVH不能降低感染性休克相关细胞因子和过敏性毒素的循环浓度，也不能减少严重脓毒症后的器官功能障碍。使用现有技术的CVVH不能被推荐作为感染性休克的辅助治疗，除非出现严重的急性肾功能衰竭。
Objective: To study the effect of early and continuous veno-venous hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients.Design: Randomized, controlled trial.Setting: Intensive care unit of a tertiary hospital.Patients: Twenty-four patients with early septic shock or septic organ dysfunction.Interventions: Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration.Measurements and Main Results: We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor a, at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 +/- 19.7) and CVVH survivors (33.2 +/- 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 +/- 1.9) and all CVVH subjects (3.3 +/- 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation.Conclusions: 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.