Abstract
Objective
To review the safety and efficacy of haemofiltration and plasmafiltration in children with severe sepsis.
Design
Retrospective case notes analysis.
Setting
University Paediatric Intensive Care Unit.
Patients
All children admitted to the intensive care unit between November 1985 and May 1992 with a primary diagnosis of severe sepsis who also received blood filtration therapy.
Interventions
Continuous haemofiltration (HF) 18 patients; continuous haemofiltration and plasmafiltration (PF) 9 patients.
Measurements and results
27 children with sepsis-induced MOSF, median age 26.6 months (range 0.33–185), median weight 12 kg (range 2.5–58), mean PRISM score 19.4 (SD 8.6), mean number of organs failing 2.78 (SD 0.9) received filtration for a median duration of 36 hours (range 2–145). Eight (30%) survived (HF5/18, PF3/9). There was no significant difference in the demographic features between the HF group and the PF group and no difference in mortality. The two groups were pooled to assess the effect of commencement of filtration on clinical wellbeing. Arterial blood gases, electrolytes, full blood examination, ventilator settings and doses of inotropes were recorded immediately prior to commencement of filtration and 18 h after commencement. Serum anion gap and osmolality were calculated using conventional formulae. There were no significant changes in the level of cardiorespiratory support, or biochemical markers of severity following commencement of filtration. Platelet count fell 32% (p=0.029) but no bleeding was encountered. No severe complications were observed during 1222 h of filtration. No bleeding or infection was observed at the site of cannulation. One child developed haemodynamic instability following commencement of plasmafiltration necessitating abandonment of the procedure.
Conclusion
Haemofiltration or plasmafiltration can be performed safely in children with severe sepsis but their effect on outcome remains unknown.
Key words: Haemofiltration Plasmafiltration, Sepsis, Novel therapies, Outcome, Safety Paediatric
References
- 1.Zobel G, Ring E, Kuttnig M, Grubbauer HM. Five years experience with continuous extracorporeal renal support in paediatric intensive care. Intensive Care Med. 1991;17:315–319. doi: 10.1007/BF01716188. [DOI] [PubMed] [Google Scholar]
- 2.Barzilay E, Kessler D, Berlot G, Gullo A, Geber D, Ben Zeev I. Use of extracorporeal supportive techniques as additional treatment for septic-induced multiple organ failure patients. Crit Care Med. 1989;17:634–637. doi: 10.1097/00003246-198907000-00007. [DOI] [PubMed] [Google Scholar]
- 3.van Deuren M, Santman FW, van Alen R, Sauerwein RS, Span LFR, van der Meer JWM. Plasma and whole blood exchange in Meningococcal Sepsis. Clin Infect Dis. 1992;15:424–430. doi: 10.1093/clind/15.3.424. [DOI] [PubMed] [Google Scholar]
- 4.Bjertnaes LJ. Plasma exchange in septic shock. In: Schlag G, Redl H, editors. First Vienna Shock Forum, Part B: Monitoring and treatment of shock. New York: Liss; 1987. pp. 215–223. [Google Scholar]
- 5.Wilkinson JD, Pollack MD, Ruttiman UE, Glass NL, Yeh TS. Outcome of pediatric patients with multiple organ system failure. Crit Care Med. 1986;14:271–274. doi: 10.1097/00003246-198604000-00002. [DOI] [PubMed] [Google Scholar]
- 6.Worthley LIG, Guerin M, Pain RW. For calculating osmolality, the simplest formula is the best. Anaesth Intensive Care. 1987;15:199–202. doi: 10.1177/0310057X8701500214. [DOI] [PubMed] [Google Scholar]
- 7.Gottloib L, Barzilay E, Shustak A, Wais Z, Jaichenko J, Lev A. Hemofiltration in septic ARDS. The artificial kidney as an artificial endocrine lung. Resusciation. 1986;13:123–132. doi: 10.1016/0300-9572(86)90016-x. [DOI] [PubMed] [Google Scholar]
- 8.Cosentino F, Paganini E, Lockrem J, Stoller J, Wiedemann H. Continuous arteriovenous hemofiltration in the adult respiratory distress syndrome. A randomized trial. Contrib Nephrol. 1991;93:94–97. doi: 10.1159/000420194. [DOI] [PubMed] [Google Scholar]
- 9.Zobel G, Trop M, Ring E, Grubbauer HM. Arteriovenous hemofiltration in children with multiple organ system failure. Int J Artif Organs. 1987;10:233–238. [PubMed] [Google Scholar]
- 10.Pollack M. Editorial response: blood exchange and plasmapheresis in sepsis and septic shock. Clin Infect Dis. 1992;15:431–433. doi: 10.1093/clind/15.3.431. [DOI] [PubMed] [Google Scholar]
- 11.Parillo JE. Pathogenetic mechanisms of septic shock. N Engl J Med. 1993;328:1471–1477. doi: 10.1056/NEJM199305203282008. [DOI] [PubMed] [Google Scholar]
- 12.Natanson C, Hoffman W, Danner R, Koev LL, Banks SM, Walker LM, Parillo JE. A controlled trial of plasmapheresis fails to improve the outcome in an antibiotic treated canine model of human septic shock. Crit Care Med. 1989;17:57. [Google Scholar]
- 13.Muraji T, Okamoto E, Hoque S, Toyosaka A. Plasma exchange therapy for endotoxin shock in puppies. J Pediatr Surg. 1986;21:1092–1095. doi: 10.1016/0022-3468(86)90016-3. [DOI] [PubMed] [Google Scholar]
- 14.Westendorp RGJ, Brand A, van Hinsbergh VWM, Thompson J, van Furth R, Meinders EA. Leukaplasmapheresis in meningococcal septic shock. Am J Med. 1992;92:577–578. doi: 10.1016/0002-9343(92)90761-y. [DOI] [PubMed] [Google Scholar]