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  • Open Access

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

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Critical Care201115 (Suppl 1) :P115

https://doi.org/10.1186/cc9535

  • Published:

Keywords

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

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
Figure 1

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.

Authors’ Affiliations

(1)
Fujita Health University School of Medicine, Toyoake, Japan

Copyright

© Nishida et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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