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Sustained high-efficiency daily diafiltration using a cytokine-adsorbing membrane in the treatment of patients with severe sepsis
© Nishida et al. 2011
- Published: 1 March 2011
- Severe Sepsis
- Fluid Resuscitation
- Adsorption Efficiency
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.
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.
Decrease in blood IL-6 level
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.
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.
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.