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Very high volume haemofiltration (VHVHF) (8.75 l/hour) sustained during a 4 hour period of time can remove by filtration significantly higher amounts of cytokine compared with low volume haemofiltration (LVHF) (1 l/hour) and is accompanied by a significant drop in cytokines only in haemodynamical responders and survivors during early severe septic shock
Critical Care volume 7, Article number: P215 (2003)
Background and objectives
It has been speculated that the beneficial effects of VHVHF in refractory septic shock [1] could be explained or not by cytokine removal. We compared the cytokine removal in 16 patients with early severe septic shock: eight were held with VHVHF and were compared with a historical cohort treated with LVHF.
Setting
General intensive care unit, regional centre.
Design
Comparative study: 16 patients in early septic shock. Eight patients were put on VHVHF (8.75 ml/hour) and were compared in term of cytokine filtration with a historical cohort of eight patients who were treated with low volume haemofiltration (1 l/hour).
Results
VHVHF was able to remove a significantly higher amount of IL-6 when compared with LVHF. The total amount removed in 1 hour by VHVHF was 40 μg/hour, significantly higher than the amount removed by LVHF, which was about 1 μg/hour (P < 0.01).
The extremely important removal was accompanied in patients treated by VHVHF by a significant drop in serum IL-6 only in responders and survivors (two out of eight). No decrease was observed in nonresponders and nonsurvivors (six out of eight) and was very minimal in the group of LVHF.
During VHVHF, serum IL-10 never dropped, whatever the outcome of the patient. These results were in agreement with two recent studies [2, 3] where the IL-6 clearance in LVHG was between 15 and 30 μg/day.
Conclusion
The beneficial effect of VHVHF in refractory septic shock can be explained at least in part by a significantly higher removal of proinflammatory cytokines compared with LVHF. In responders and survivors, this was accompanied by a significant decrease in serum proinflammatory cytokines levels, whereas IL-10 levels did not change at all.
References
Honoré P, et al.: Crit Care Med 2000, 28: 3581-3587. 10.1097/00003246-200011000-00001
Bellomo R, et al.: Crit Care Med 1993, 21: 522-526.
De Vrien A, et al.: J Am Soc Nephrol 1999, 10: 846-853.
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Honoré, P., Ernst, Y., Jamez, J. et al. Very high volume haemofiltration (VHVHF) (8.75 l/hour) sustained during a 4 hour period of time can remove by filtration significantly higher amounts of cytokine compared with low volume haemofiltration (LVHF) (1 l/hour) and is accompanied by a significant drop in cytokines only in haemodynamical responders and survivors during early severe septic shock. Crit Care 7 (Suppl 2), P215 (2003). https://doi.org/10.1186/cc2104
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DOI: https://doi.org/10.1186/cc2104