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01.09.2008 | Original

A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock

verfasst von: Nicolas Boussekey, Arnaud Chiche, Karine Faure, Patrick Devos, Benoit Guery, Thibaud d’Escrivan, Hugues Georges, Olivier Leroy

Erschienen in: Intensive Care Medicine | Ausgabe 9/2008

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Abstract

Objective

High volume hemofiltration (HVHF) has shown potential benefits in septic animals and a few reports suggested a hemodynamic improvement in humans. However, randomized studies are still lacking. Our goal was to evaluate the hemodynamic effects of HVHF in septic shock patients with acute renal failure (ARF).

Design and setting

Prospective randomized study in an intensive care unit (ICU).

Patients

Twenty patients with septic shock and ARF.

Interventions

Patients were randomized to either high volume hemofiltration [HVHF 65 ml/(kg h)] or low volume hemofiltration [LVHF 35 ml/(kg h). Vasopressor dose was adjusted to reach a mean arterial pressure (MAP) > 65 mmHg.

Measurements and results

We performed six hourly measurements of MAP, norepinephrine dose, PaO₂/FiO₂ and lactate, and four daily urine output and logistic organ dysfunction (LOD) score. Baseline characteristics of the two groups were comparable on randomization. Mean norepinephrine dose decreased more rapidly after 24 h of HVHF treatment compared to LVHF treatment (P = 0.004) whereas lactate and PaO₂/FiO₂ did not differ between the two treatment groups. During the 4-day follow-up, urine output was slightly increased in the HVHF group (P = 0.059) but the LOD score evolution was not different. Duration of mechanical ventilation, renal replacement therapy and ICU length of stay were also comparable. Survival on day 28 was not affected.

Conclusion

HVHF decreased vasopressor requirement and tended to increase urine output in septic shock patients with renal failure. However, a larger trial is required to confirm our results and perhaps to show a benefit in survival.

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Titel: A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock
verfasst von: Nicolas Boussekey
Arnaud Chiche
Karine Faure
Patrick Devos
Benoit Guery
Thibaud d’Escrivan
Hugues Georges
Olivier Leroy
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1127-3

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A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock