The Selection Of Hemofiltration Regimen In Sepsis

The results of a clinical trial using different high — volume hemofiltration regimens in surgical patients with sepsis is presented.

Objective: improvement the clinical outcomes by inclusion the various regimens of a highvolume hemofiltration in the intensive therapy of patients with sepsis and septic shock.

Materials and methods: The study enrolled 46 patients. Twentyfour patients underwent intermittent very high volume hemofiltration (IHVH) with a replacement volume of 100 ml/kg/h for 4 hours and 22 patients were provided by continuous highvolume hemofiltration (CHVH) with an ultrafiltration dose of 50 ml/kg/h for 48 hours.

Results. In the IHVH group, 28day mortality was 29,2% that was significantly differed from that in the CHVH group (40,9%). The investigation revealed that a body mass index of more than 25 kg/m2 was a contraindications to IHVH.

Conclusion. There were positive changes in the patient's condition associated with the stabilization of the circulatory system and the normalization of the oxygentransport function. These changes persisted during and after the IHVH and were similarly observed in the CHVH group. Patients with high body weight (more than 25 kg/m2) required special blood flow velocity regimen (320—350 ml per minute). Maintaining fraction of filtration for less than 25% and preventing thrombosis hemofilter during IHVH was crucial for effective treatment.

1. Singer M., Deutschman C.S., Seymour C.W., ShankarHari M., Annane D., Bauer M., Bellomo R., Bernard G.R., Chiche J.D., Coopersmith C.M., Hotchkiss R.S., Levy M.M., Marshall J.C., Martin G.S., Opal S.M., Rubenfeld G.D., van der Poll T., Vincent J.L., Angus D.C. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis3). JAMA. 2016; 315 (8): 801–810. http://dx.doi.org/10.1001/ jama.2016.0287. PMID: 26903338

2. Kozlov V.K. Sepsis: etiologiya, immunopatogenez, kontseptsiya sovremennoi imunnoi terapii. [Sepsis: etiology, immunopathogenesis, concept of modern immunotherapy]. Kiev: AnnaT; 2007: 296. [In Russ.]

3. Ketlinsky S.A., Kalinina N.M. Immunologiya dlya vracha. [Immunology for physician]. SanktPeterburg: Gippokrat; 1998: 156. [In Russ.]

4. Cole L., Bellomo R., Hart G., Journois D., Davenport P., Tipping P., Ronco C. A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit. Care Med. 2002; 30 (1): 100–106. http://dx.doi.org/10.1097/0000324620020100000016. PMID: 11902250

5. Saidkhanov B.A., Gutnikova A.R., Abdullaeva M.A., Ziyamuddinov N.A. Vliyanie okislitelnoi modifikatsii gemosorbenta na effektivnost ochishcheniya krovi u bolnykh s poliorgannoi nedostatochnostyu. [Influence of oxidative modification of a hemosorbent on efficiency of clearification of blood at patients witpolyorgan insufficiency]. Efferentnaya Terapiya. 2009; 15 (3–4): 28–31. [In Russ.]

6. Lee K.H., Wendon J., Lee M., Da Costa M., Lim S.G., Tan K.C. Predicting the decrease of conjugated bilirubin with extracorporeal albumin dialysis MARS using the predialysis molar ratio of conjugated bilirubin to albumin. Liver Transpl. 2002; 8 (7): 591–593. http://dx.doi.org/10.1053/jlts.2002.34148. PMID: 12089711

7. Macias W.L., Mueller B.A., Scarim S.K., Robinson M., Rudy D.W. Continuous venovenous hemofiltration: an alternative to continuous arteriovenous hemofiltration and hemodiafiltration in acute renal failure. Am. J. Kidney Dis. 1991; 18 (4): 451–458. http://dx.doi.org/10.1016/s02726386(12)801132. PMID: 1928064

8. Neveu H., Kleinknecht D., Brivet F., Loirat P., Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure.Nephrol. Dial. Transplant. 1996; 11 (2): 293–299. http://dx.doi.org/10.1093/oxfordjournals.ndt.a027256. PMID: 8700363

9. Ronco С., Bellomo R., Kellum J.A. Critical care nephrology. Elsevier Health Sciences; 2008: 1848.

10. Ronco C., Tetta C., Mariano F., Wratten M.L., Bonello M., Bordoni V., Cardona X., Inguaggiato P., Pilotto L., d’Intini V., Bellomo R. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif. Organs. 2003; 27 (9): 792–801. http://dx.doi.org/10.1046/j.15251594.2003.07289.x. PMID: 12940901

11. Yakovleva I.I., Timokhov V.S., Lyalikova G.V., Pestryakov E.V., Moroz V.V., Muravyev O.B., Sergeyev A.Yu. Vysokoobyemnaya gemodiafiltrat siya v lechenii sepsisa i poliorgannoi nedostatochnosti: dva sposoba eliminatsii TNFα. [Highvolume hemodiafiltration in the treatment of sepsis and multiple organ failure: 2 methods of the elimination of TNFalpha]. Anesteziologiya i Reanimatologiya. 2001; 2: 46–48. PMID: 11494901. [In Russ.]

12. Khoroshilov S.E., Nikulin A.V. Efferentnoe lechenie kriticheskikh sostoyanii. Obshchaya Reanimatologiya. [Efferent treatment for critical conditions. General Reanimatology]. 2012; 8 (4): 30–41. http://dx.doi.org/10.15360/181397792012430. [In Russ.]

13. Khoroshilov S.E., Nikulin A.V., Bazhina E.S. Vliyanie ekstrakorporalnoi detoksikatsii na tkanevuyu perfuziyu pri septicheskom shoke. [Influence of extracorporeal detoxification methods on tissue perfusion in septic shock]. Anesteziologiya i Reanimatologiya. 2015; 60 (5): 65–67. PMID: 26852583. [In Russ.]

14. Bazhina E.S., Nikulin A.V., Khoroshilov S.E. Ekstrakorporalnye metody lecheniya abdominalnogo sepsisa. Obshchaya Reanimatologiya. [Extracorporeal treatments for abdominal sepsis. General Reanimatology]. 2015; 11 (5): 45–66. http://dx.doi.org/10.15360/18139779201554566. [In Russ.]

15. Khoroshilov S.E., Beloborodova N.V., Nikulin A.V., Bedova A.Yu. Vliyanie ekstrakorporalnoi detoksikatsii na uroven aromaticheskikh mikrobnykh metabolitov v syvorotke krovi pri infektsionnykh oslozhneniyakh. Obshchaya Reanimatologiya. [Impact of extracorporeal detoxification on the serum levels of microbial aromatic acid metabolites in sepsis. General Reanimatology]. 2015; 11 (5): 6–14. http://dx.doi.org/10.15360/1813977920155614. [In Russ.]

16. Devnozashvili Sh.Sh., Fedorovsky N.M. Prolongirovannaya nizkopotochnaya gemodiafiltratsiya (PRISMA) v kompleksnom lechenii khirurgicheskogo endotoksikoza. [Prolonged lowflow hemodiafiltration (PRISMA) in complex treatment of surgical endotoxicosis]. Klinicheskaya Anesteziologiya i Reanimatologiya. 2004; 1 (3): 16. [In Russ.]

17. Dellinger R.P., Levy M.M., Carlet J.M., Bion J., Parker M.M., Jaeschke R., Reinhart K., Angus D.C., BrunBuisson C., Beale R., Calandra T., Dhainaut J.F., Gerlach H., Harvey M., Marini J.J., Marshall J., Ranieri M., Ramsay G., Sevransky J., Thompson B.T., Townsend S., Vender J.S., Zimmerman J.L., Vincent J.L.; International Surviving Sepsis Campaign Guidelines Committee; American Association of CriticalCare Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine; European Respiratory Society; International Sepsis Forum; Japanese Association for Acute Medicine; Japanese Society of Intensive Care Medicine;Society of Critical Care Medicine; Society of Hospital Medicine; Surgical Infection Society; World Federation of Societies of Intensive and Critical Care Medicine. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit. Care Med. 2008; 36 (1): 296–327. http://dx.doi.org/10.1097/01.ccm.0000298158.12101.41 PMID: 18158437

18. Ronco C., Bellomo R., Homel P., Brendolan A., Dan M., Piccinni P., La Greca G. Effects of different doses in continuous venovenous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000; 356 (9223): 26– 30. http://dx.doi.org/10.1016/s01406736(00)024302. PMID: 12371727

19. Klouche K., Cavadore P., Portales P., Clot J., Canaud B., Béraud J. J. Continuous venovenous hemofiltration improves hemodynamics in septic shock with acute renal failure without modifying TNFalpha and IL6 plasma concentrations. J. Nephrol. 2001; 15 (2): 150–157. PMID: 12018631

20. Boussekey N., Chiche A., Faure K., Devos P., Guery B., d’Escrivan T., Georges H., Leroy O. A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock. Intensive Care Med. 2008; 34 (9): 1646–1653. http://dx.doi.org/10.1007/s0013400811273. PMID: 18542921

21. Honoré P.M., Jacobs R., Boer W., JoannesBoyau O., De Regt J., De Waele E., Van Gorp V., Collin V., Spapen H.D. New insights regarding rationale, therapeutic target and dose of hemofiltration and hybrid therapies in septic acute kidney injury. Blood Purif. 2011; 33 (1–3): 44–51. http://dx.doi.org/10.1159/000333837. PMID: 22179226

22. JoannesBoyau O., Honoré P.M., Perez P., Bagshaw S.M., Grand H., Canivet J.L., Dewitte A., Flamens C., Pujol W., Grandoulier A.S., Fleureau C., Jacobs R., Broux C., Floch H., Branchard O., Franck S., Rozé H., Collin V., Boer W., Calderon J., Gauche B., Spapen H.D., Janvier G., Ouattara A. Highvolume versus standardvolume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013; 39 (9): 1535–1546. http://dx.doi.org/10.1007/s001340132967z. PMID: 23740278

23. Ratanarat R., Brendolan A., Piccinni P., Dan M., Salvatori G., Ricci Z., Ronco C. Pulse highvolume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival. Crit. Care. 2005; 9 (4): R294–R302. http://dx.doi.org/10.1186/cc3529. PMID: 16137340

24. Fomin A.M., Vatazin A.V., Kruglov E.E., Koshelev R.V., Chemeris A.N. Sravnitelnaya otsenka effertivnosti razlichnykh metodik gemofiltratsii pripoliorgannoi nedostatochnosti u bolnykh s gnoinosepticheskimi oslozhneniyami zabolevanii organov bryushnoi polosti. [Comparative estimation of different hemofiltration methods efficacy in patients with multiple organ failure associated with pyoseptic complications of abdominal diseases]. Almanakh Klinicheskoi Meditsiny. 2009; 20: 71–76. [In Russ.]

25. Di Carlo J.V., Alexander S.R. Hemofiltration for cytokinedriven illnesses: the mediator delivery hypothesis. Int. J. Artif. Organs. 2005; 28 (8): 777–786. PMID: 16211527

26. Yakovleva I.I., Timokhov V.S., Molchanova L.V., Pestryakov E.V., Moroz V.V., Muravyev O.B., Sergeyev A.Yu. Kineticheskoe modelirovanie pripostoyannoi gemofiltratsii u bolnykh s sepsisom i poliorgannoi nedostatochnostyu. [Kinetic modeling during continuous hemodiafiltration in patients with sepsis and multiorgan failure]. Anesteziologiya i Reanimatologiya. 2002; 6: 52–55. PMID: 12611159. [In Russ.]

27. Meisner M. Procalcitoninbiochemistry and clinical diagnosis. 1st ed. Bremen: UNIMED; 2010: 125.