Related Experiment Videos
Cytokine removal during continuous hemofiltration in septic patients
A S De Vriese1, F A Colardyn, J J Philippé
1Renal Division of the Department of Medicine, University Hospital, Gent, Belgium. an.devriese@rug.ac.be
Journal of the American Society of Nephrology : JASN
|April 15, 1999
Summary
Continuous venovenous hemofiltration (CVVH) effectively removes inflammatory cytokines in septic shock patients. Optimizing blood flow and frequent membrane changes enhances cytokine clearance, potentially improving treatment strategies.
Area of Science:
- Critical Care Medicine
- Nephrology
- Biomedical Engineering
Background:
- Continuous renal replacement therapies (CRRT) are explored for extracorporeal removal of inflammatory mediators in sepsis.
- Previous studies showed cytokine elimination with CRRT but lacked significant impact on serum concentrations.
- Understanding cytokine removal mechanisms is crucial for developing effective treatments.
Purpose of the Study:
- To investigate cytokine removal mechanisms during continuous venovenous hemofiltration (CVVH) in septic shock patients.
- To evaluate the impact of membrane changes and blood flow rates on cytokine elimination.
- To determine optimal parameters for enhanced cytokine removal via CVVH.
Main Methods:
- A study involving 15 septic shock patients with acute renal failure undergoing CVVH using an AN69 membrane.
- Hemofilter replacement and blood flow rate (QB) adjustments (100 ml/min vs. 200 ml/min) were implemented after 12 hours.
- Pre- and postfilter plasma and ultrafiltrate cytokine concentrations were measured for mass balance calculations.
Main Results:
- Cytokine removal peaked 1 hour post-CVVH initiation and after membrane changes (25-43%), correlating with reduced serum cytokine levels.
- Both inflammatory and anti-inflammatory cytokines were removed similarly.
- Adsorption to the AN69 membrane was the primary clearance mechanism, most effective with new membranes and decreasing with saturation.
- Higher QB (200 ml/min) increased ultrafiltration, convective elimination, and membrane adsorption compared to lower QB (100 ml/min).
Conclusions:
- CVVH with AN69 membranes can significantly reduce cytokine levels in septic shock patients.
- Optimal cytokine removal is achieved by combining high blood flow/ultrafiltration rates with frequent membrane exchanges.
- These findings suggest improved CRRT strategies for sepsis management through optimized CVVH parameters.