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

被引:67
作者
Chung, Kevin K. [1 ,2 ]
Coates, Elsa C. [3 ]
Smith, David J., Jr. [4 ]
Karlnoski, Rachel A. [4 ]
Hickerson, William L. [5 ]
Arnold-Ross, Angela L. [5 ]
Mosier, Michael J. [6 ]
Halerz, Marcia [6 ]
Sprague, Amy M. [7 ]
Mullins, Robert F. [7 ]
Caruso, Daniel M. [8 ]
Albrecht, Marlene [8 ]
Arnoldo, Brett D. [9 ]
Burris, Agnes M. [9 ]
Taylor, Sandra L. [10 ]
Wolf, Steven E. [9 ]
机构
[1] Brooke Army Med Ctr, Ft Sam Houston, TX 78234 USA
[2] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
[3] US Army, Inst Surg Res, Ft Sam Houston, TX 78234 USA
[4] Univ S Florida, Tampa Gen Hosp, Tampa, FL USA
[5] Univ Tennessee, Firefighters Reg Burn Ctr, Memphis, TN USA
[6] Loyola Univ, Med Ctr, 2160 S 1st Ave, Maywood, IL 60153 USA
[7] Doctors Hosp Joseph M Still Burn Ctr, Augusta, GA USA
[8] Arizona Burn Ctr Maricopa Integrated Hlth Syst, Phoenix, AZ USA
[9] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
[10] Univ Calif Davis, Sacramento, CA 95817 USA
来源
CRITICAL CARE | 2017年 / 21卷
关键词
High-volume hemofiltration; Burns; Septic shock; Acute kidney injury; Randomized controlled trial; Multicenter; CRITICALLY-ILL PATIENTS; POLYMYXIN-B HEMOPERFUSION; ACUTE-RENAL-FAILURE; ORGAN DYSFUNCTION; SEPSIS; ASSOCIATION; INTENSITY; OUTCOMES;
D O I
10.1186/s13054-017-1878-8
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
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页数:8
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