Skip to main content

Sustained high-efficiency daily diafiltration using a cytokine-adsorbing membrane in the treatment of patients with severe sepsis

Introduction

Sustained high-efficiency daily hemodiafiltration using a cytokine-adsorbing membrane (SHEDD-fA) is an effective modality for sepsis treatment. Here we describe the effectiveness of SHEDD-fA, which makes the best use of three principles for solute removal, in the treatment of severe sepsis.

Methods

Twenty-nine septic shock patients were analyzed retrospectively. SHEDD-fA was initiated after adequate fluid resuscitation and catecholamine support. Operation conditions were QB = 150 ml/minute, QF = 1,500 ml/hour (post-dilution) and QD = 300 to 500 ml/minute using an HD machine over 8 to 12 hours daily. For the purpose of maximizing cytokine adsorption efficiency, we used a large-size (2.1 m2) PMMA dialyzer.

Results

Decrease in blood IL-6 level

SHEDD-fA was performed for 3 days. The percentage of IL-6 removed from the blood was 84.4 ± 25.8% (mean ± SD; P < 0.01; n = 25; Figure 1). In addition, we simultaneously assayed both inlet and outlet IL-6 and found a 21.0 ± 13.4% (P < 0.01; n = 25) removal ratio, showing that IL-6 is effectively removed after one pass through the hemofilter. Moreover, depressed monocytic HLA-DR ratio was improved from 40.6 to 51.9% in one typical case.

Figure 1
figure1

Decrease in blood IL-6 level over 3 days (left) and the removal ratio in one pass (right).

Hemodynamics and PaO2/FiO2 improvement

In 22 out of the 29 septic shock patients, significant decreases in the catecholamine index/mean blood pressure were observed 3 hours after the initiation of SHEDD-fA (P < 0.01). In septic ARDS patients, PaO2/FiO2 was significantly improved at 1 hour (P < 0.01). The improvement of the abovementioned parameters continued afterwards for 72 hours. As a result, 13 of 16 patients survived.

Conclusions

We propose the use of a large-size, cytokine-adsorbing hemofilter (PMMA or AN69 based membrane) and the selection of a suitable duration modality in the treatment of severe sepsis.

Author information

Affiliations

Authors

Corresponding author

Correspondence to O Nishida.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Nishida, O., Nakamura, T., Kuriyama, N. et al. Sustained high-efficiency daily diafiltration using a cytokine-adsorbing membrane in the treatment of patients with severe sepsis. Crit Care 15, P115 (2011). https://doi.org/10.1186/cc9535

Download citation

Keywords

  • Catecholamine
  • PMMA
  • Severe Sepsis
  • Fluid Resuscitation
  • Adsorption Efficiency