Feature Articles

Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: A randomized controlled trial*

Payen, Didier MD, PhD; Mateo, Joaquim MD; Cavaillon, Jean Marc PhD; Fraisse, François MD; Floriot, Christian MD; Vicaut, Eric MD, PhD for the Hemofiltration and Sepsis Group of the Collège National de Réanimation et de Médecine d’Urgence des Hôpitaux extra-Universitaires

Author Information

From the Department of Anesthesiology and Critical Care Medicine (DPJ, JM), Lariboisière Hospital, University Paris, Paris, France; Unit Cytokines & Inflammation (JMC), Institut Pasteur, Paris, France; Department of Intensive Care (FF), Delafontaine Hospital, Saint-Denis, France; Department of Intensive Care (CF), P. Morel Hospital, Vesoul, France; and Unité de Recherche Clinique (EV), Fernand-Widal University Hospital, Paris, France.

Supported, in part, by the Plan Quadriennal de Ministère de la Recherche, EA 322, and from Baxter/Edwards Life Sciences for hemofiltration materials, logistic support, and statistical analysis.

Presented as an abstract at the SCCM meeting in Phoenix in 2005.

Didier Payen holds a consultant contract with Edwards Life Sciences, and received a grant for research not related to the present study. The remaining authors have not disclosed any conflicts of interest.

Authors’ Contributions: As principal investigators of the Hemofiltration and Sepsis Study group trial, Drs. Payen and Fraisse had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Payen, Fraisse, Vicaut, Floriot, and Moret. Acquisition of data: Payen, Mateo, and Cavaillon. Analysis of data: Payen, Mateo, Cavaillon. Drafting of the manuscript: Payen, Mateo, and Cavaillon. Critical revision of the manuscript for important intellectual content: Payen and Cavaillon. Statistical expertise: Independent company, Vicaut, Payen, and Mateo. Study supervision: Payen.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 37(3):p 803-810, March 2009. | DOI: 10.1097/CCM.0b013e3181962316

Abstract

Objective:

The impact of continuous venovenous hemofiltration on sepsis-induced multiple organ failure severity is controversial. We sought to assess the effect of early application of hemofiltration on the degree of organ dysfunction and plasma cytokine levels in patients with severe sepsis or septic shock.

Design:

Prospective, randomized, open, multicenter study setting, 12 French intensive care units.

Patients:

A total of 80 patients were enrolled within 24 hours of development of the first organ failure related to a new septic insult.

Interventions:

Patients were randomized to group 1 (HF), who received hemofiltration (25 mL/kg/hr) for a 96-hour period, or group 2 (C) who were managed conventionally.

Measurements and Main Results:

The primary end point was the number, severity, and duration of organ failures during 14 days, as evaluated by the Sepsis-Related Organ Failure Assessment score, on an intention-to-treat analysis. Strict guidelines were provided to perform continuous hemofiltration under the same conditions and bearing the same objectives in all centers. Because of inclusion stagnation, the trial was discontinued after an interim analysis by which time 76 patients had been randomized. The number and severity of organ failures were significantly higher in the HF group (p < 0.05). No modifications in plasma cytokine levels could be detected.

Conclusion:

These data suggest that early application of standard continuous venovenous hemofiltration is deleterious in severe sepsis and septic shock. This study does not rule out an effect of high-volume hemofiltration (>35 mL/kg/hr) on the course of sepsis.