The online version of this article (doi:10.1186/s13054-017-1878-8) contains supplementary material, which is available to authorized users.
Presented as an oral presentation at the 49th American Burn Association Annual Meeting in Boston MA, USA on 24 March 2017.
Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population.
We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices.
During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups.
HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined.
Clinicaltrials.gov NCT01213914. Registered 30 September 2010.
Additional file 1: Contains supplementary methods, Table S1 presenting comparison of hemodynamic parameters between control and HVHF groups at baseline (hour 0) and hour 48 and comparison of change in hemodynamic parameters between baseline and hour 48 for each group, Table S2 presenting physiologic and laboratory characteristics (mean ± SD) at hours 0, 24, and 48, Table S3 presenting p values for comparisons of physiologic and laboratory characteristics of controls to HVHF subjects at 0, 24, and 48 hours, and lists IRBs. (DOCX 27 kb)13054_2017_1878_MOESM1_ESM.docx
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- High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial
Kevin K. Chung
Elsa C. Coates
David J. Smith Jr
Rachel A. Karlnoski
William L. Hickerson
Angela L. Arnold-Ross
Michael J. Mosier
Amy M. Sprague
Robert F. Mullins
Daniel M. Caruso
Brett D. Arnoldo
Agnes M. Burris
Sandra L. Taylor
Steven E. Wolf
for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators
- BioMed Central
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