Inline filtration reduces the incidence of systemic inflammatory response syndrome in critically ill children

Introduction

Particulate contamination of infusion solution implies a potential health risk for intensive care patients with a background of debilitation and impaired host responses. Particles have been shown to induce thrombogenesis, deterioration of microcirculation and modulation of immunoresponse. We assessed the effect of inline filtration on the reduction of major complications in critically ill children (Clinical Trials.gov ID NCT 00209768).

Methods

In a randomised, prospective trial, paediatric patients admitted to the interdisciplinary pediatric ICU of a tertiary university hospital were assigned to either a control or an interventional group, the latter receiving inline filtration (infusion filter Pall ELD96LLCE/NOE96E, Braun Intrapur Lipid/Intrapur Neonat Lipid) throughout infusion therapy. Prior to this study, the infusion regimen was optimised to prevent precipitation and incompatibilities of solutions and drugs. Primary objectives were a reduction in the incidence of sepsis, thrombosis, systemic inflammatory response syndrome (SIRS) or organ failure (liver, lung, kidney, circulation).

Results

Interim analysis of 398 children (171 female, 227 male, mean age 72 months) revealed a heterogeneous background of underlying diagnoses and a Gaussian distribution to either the control group (208 patients) or inline filtration group (190 patients). First analyses demonstrated a significant reduction in the incidence of SIRS for the interventional group (95% CI = 68 to 112; P < 0.035).

Conclusion

The occurrence of sepsis, SIRS, thrombosis or organ failure often complicates the course of disease in critically ill patients. Inline filtration is most effective reducing the incidence of SIRS. Additional analyses are expected to confirm the preliminary results as well as to further identify the influence of inline filtration on other complications.