Effectiveness of continuous venovenous hemodiafiltration using a polymethylmethacrylate membrane hemofilter in septic shock patients

Introduction

Septic shock is a condition associated with diffuse coagulopathy and multiple organ failure, and frequently ends in death. The effectiveness of continuous venovenous hemodiafiltration (CVVHDF) using a polymethylmethacrylate membrane hemofilter (PMMA) for critically ill patients has also been reported.

Methods

We treated 18 septic shock patients by CVVHDF. The patients were divided into two groups: namely, a group in which CVVHDF using PMMA therapy was added (11 cases), and a group in which CVVHDF using a polyacrylonitrile membrane hemofilter (CVVHDF using PAN) therapy was added (seven cases). The outcomes in the two groups were compared.

Results

The average APACHE II score and the average SOFA score were not significantly different between the two groups. The CVVHDF using PMMA group showed significantly better outcomes, with significant improvements of the serum plasminogen activator inhibitor 1 (PAI-1), protein C, IL-6 and N-arachidonoylethanolamine (AEA) levels.

Conclusion

Therapies aimed at blood purification, such as CVVHDF, continuous hemofiltration and plasma exchange have been reported to be effective for the removal of inflammatory cytokines and various mediators. Few reports have shown the influence of the column used for CVVHDF on the removal efficiency of the abovementioned factors, although several columns have been used in CVVHDF. CVVHDF using PMMA has been reported to be effective for cytokine removal. Our findings suggest removal of IL-6, AEA and PAI-1 by CVVHDF using PMMA; and CVVHDF using PMMA resulted in better outcomes and an improved survival rate in septic shock patients.