Systemic inflammatory response syndrome is reduced by inline filtration in intensive care patients

Introduction

Sepsis, systemic inflammatory response syndrome (SIRS) or organ failure often complicate the clinical course on an ICU. Particulate contamination of the infusion solution may contribute to the clinical deterioration of these patients. Particles have been shown to induce thrombogenesis, deterioration of microcirculation and modulation of immunoresponse. The use of inline filtration with microfilters almost completely prevents particulate infusion. 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 807 paediatric patients admitted to the interdisciplinary PICU 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 the whole infusion therapy. Prior to this study, the infusion regimen was optimised to prevent precipitation and incompatibilities of solutions and drugs. Primary objectives included a reduction in the incidence of sepsis, thrombosis, SIRS, organ failure (liver, lung, kidney, circulation) and mortality.

Results

eight hundred and seven children (343 female, 464 male) with a heterogeneous background of underlying diagnoses and a Gaussian distribution to either the control group (406 patients) or the inline filtration group (401 patients) were included. According to the study criteria, a significant reduction in the incidence of SIRS for the interventional group (95% CI, 145 versus 200 patients, P < 0.001) was evident. No differences were demonstrated for the occurrence of sepsis, thrombosis, organ failure (liver, lung, kidney, circulation) or mortality between the control and interventional groups.

Conclusions

The occurrence of SIRS often complicates the treatment in intensive care medicine. Inline filtration is most effective, reducing the incidence of SIRS, and offers a novel therapeutic option.