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Table 1 The main studies describing the effectiveness/limitations of high volume hemofiltration

From: Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

  Honoré et al. 2000 [18] Cole et al. 2001 [15] Joannes-Boyau et al. 2004 [12] Ratanarat et al. 2005 [19] Cornejo et al. 2006 [14] Piccinni et al. 2006 [13] Boussekey et al. 2008 [16] Joannes-Boyau et al. 2013 [17] (IVOIRE)
Study design Cohort, uncontrolled prospective Randomized crossover Cohort, uncontrolled prospective Cohort, uncontrolled prospective Cohort, uncontrolled prospective Retrospective Prospective randomized study Prospective, randomized, open, multicenter
Study population (n) 20 septic shock patients 11 septic shock patients 24 septic shock patients 15 severe sepsis patients 20 septic shock patients 80 septic shock patients 20 septic shock patients and AKI 140 septic shock patients and AKI
Prescribed dose HVHF (4 h, 35 L of UF removed) followed by conventional CVVH for at least 4 days 8 h of HVHF (6 L/h) or 8 h of standard CVVH (1 L/h) 40–60 ml/kg/h for 96 h HVHF 85 ml/kg/h for 6–8 h followed by CVVH 35 ml/kg/h for 16–18 h 100 ml/kg/h
Single session of 12 h
HVHF (40 patients) at 45 ml/kg/h over 6 h followed by conventional CVVH compared to 40 historic patients treated with conventional therapy HVHF 65 ml/(kg h) vs LVHF 35 ml/(kg h) HVHF at 70 ml/kg/h vs SVHF at 35 ml/kg/h for 96 h
Survival/mortality 28-day observed survival of 45% compared to expected of 21% (p < 0.05) Hospital mortality 54.5% 28-day mortality of 46% compared to predicted mortality of 70% (p < 0.075) 28-day mortality of 47% compared to predicted mortality of 68–72% Observed hospital survival of 60% compared to expected survival of 37% (p < 0.03) 28-day survival of 55% compared to 27.5% in the conventional group (p < 0.05) • ICU mortality of 33.3% in HVHF group vs 60% in LVHF group but not significantly different
• 28-day mortality of 33.3% in the HVHF
• group vs 50% in the LVHF group
• 28 day mortality of 37.9% in HVHF vs 40.8% in SVHF, (p = 0.94)
• No difference in 60 and 90 days mortality
Length of ICU stay Significant improvement (p < 0.002) No difference No difference
Hemodynamics Improvement in 11/20 patients Greater reduction in NE, HVHF vs standard CVVH (68% vs 7%; p = 0.02) Significant improvement (p < 0.05) Significant improvement (p = 0.001) Improvement in 11/20 patients Significant improvement (p < 0.05) Improvement in VP dose in the treatment group (p = 0.004) No difference
Safety No AE No AE Hypokalemia (30% in HVHF vs 20% in SVHF (p = 0.1)
Hypophosphatemia 88% in HVH vs 38 in SVHF (p = 0.01)
  1. HVHF high volume hemofiltration, LVHF low volume hemofiltration, SVHF standard volume hemofiltration, CVVH continuous veno-venous hemofiltration, UF ultrafiltrate, h hour, kg kilogram, NE norepinephrine, AE adverse events, VP vasopressor