High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial.

Autor: Chung KK; Brooke Army Medical Center, Fort Sam Houston, TX, USA. kevin.k.chung.mil@mail.mil.; Uniformed Services University of the Health Sciences, Bethesda, MD, USA. kevin.k.chung.mil@mail.mil., Coates EC; United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA., Smith DJ Jr; University of South Florida Tampa General Hospital, Tampa, FL, USA., Karlnoski RA; University of South Florida Tampa General Hospital, Tampa, FL, USA., Hickerson WL; University of Tennessee Firefighters' Regional Burn Center, Memphis, TN, USA., Arnold-Ross AL; University of Tennessee Firefighters' Regional Burn Center, Memphis, TN, USA., Mosier MJ; Loyola University Medical Center, Maywood, IL, USA., Halerz M; Loyola University Medical Center, Maywood, IL, USA., Sprague AM; Doctors Hospital Joseph M. Still Burn Center, Augusta, GA, USA., Mullins RF; Doctors Hospital Joseph M. Still Burn Center, Augusta, GA, USA., Caruso DM; Arizona Burn Center Maricopa Integrated Health Systems, Phoenix, AZ, USA., Albrecht M; Arizona Burn Center Maricopa Integrated Health Systems, Phoenix, AZ, USA., Arnoldo BD; University of Texas Southwestern Medical Center, Dallas, TX, USA., Burris AM; University of Texas Southwestern Medical Center, Dallas, TX, USA., Taylor SL; University of California Davis, Sacramento, CA, USA., Wolf SE; University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2017 Nov 25; Vol. 21 (1), pp. 289. Date of Electronic Publication: 2017 Nov 25.
DOI: 10.1186/s13054-017-1878-8
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Trial Registration: Clinicaltrials.gov NCT01213914 . Registered 30 September 2010.
Databáze: MEDLINE
Externí odkaz: