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High dose hemofiltration in the intensive care of sepsis in cancer patients

Surgical operations, chemotherapy or/and radiotherapy often cause critical forms of organ failure in cancer patients. Mortality in multiorgan failure cancer patients inducted by sepsis is about 97–100%. High-dose haemofiltration (CHDHF) or haemodia-filtration (CHDHDF) early application in sepsis treatment promotes the organ failure recovery and reduces lethality in cancer patients. One hundred and fifty-six patients (APACHE II = 32.3 ± 3.6) with multiorgan failure were studied in the Cancer Research Center in Moscow. All patients received CHDHF or CHDHDF as well as standard intensive care. Seventy-six of these patients suffered from acute sepsis. The expected and real mortality were compared within the groups of patients with and without sepsis. The cytokine and medium molecular substances concentrations were measured in the blood, urine and in the filtrate.

CHDHF and CHDHDF were performed with Fresenius and Edwards equipment with the substrate flow up to 10000 ml/hour in the 42% predilution and 58% postdilution mode. The treatment duration varied from 2 to 25 days. The average substitution volume in all patients was 4–9 l/hour. The filtration fraction equal to 33% of blood flow can be safely reached at Hct = 20–25%. The membrane was replaced every 36 hours in spite of the absence of polyestersulphone membrane thrombosis. MALDI analysis and electrophoresis were used for protein detection in filtrate. It was found that during CHDHDF the proteins with molecular weight up to 77 kDa are eliminated. This fraction contains 29–31% of albumin and 11–17% of transferrin. The excess of associated proinflammatory cytokines are also eliminated with high efficiency. The C3 component of complement system, leukotriene B4, and thromboxane are not eliminated.

CHDHF and CHDHDF were hemodynamically tolerant in all patients. In nonseptic patients (n = 74) with MOF the mortality was 52%, which is statistically significant in retrospective comparison with patients without HDF (P < 0.01). In septic patients with MOF the mortality was 82% (P < 0.01 in retrospective comparison with patients without HDF). The application of CHDHF and CHDHDF immediately after the diagnosis 'septic shock' was made (n = 16) permitted one to stop the shock development within 8–20 hours in all patients. The organ failure recovery in CHDHF and CHDHDF patients varied from 7 to 93 days. The further quality of life was determined by the treatment efficiency and by the recovery degree of organ function.

In conclusion, CHDHF and CHDHDF are safe and efficient in early application in cancer patients with MOF intensive care. Vitally important proteins losses must be calculated and compensated.

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Gromova, E., Vohminova, D., Kisselevsky, M. et al. High dose hemofiltration in the intensive care of sepsis in cancer patients. Crit Care 10 (Suppl 1), P286 (2006).

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