A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock

Area of Science:

• Nephrology
• Critical Care Medicine
• Intensive Care Unit

Background:

• High volume hemofiltration (HVHF) shows promise in animal models of sepsis.
• Limited human studies suggest potential hemodynamic benefits of HVHF.
• Randomized controlled trials are needed to validate HVHF's efficacy in human septic shock.

Purpose of the Study:

• To evaluate the hemodynamic effects of HVHF in patients with septic shock and acute renal failure (ARF).
• To compare HVHF with low volume hemofiltration (LVHF) in this patient population.

Main Methods:

• Prospective randomized study conducted in an intensive care unit (ICU).
• Twenty patients with septic shock and ARF were randomized to HVHF (65 ml/kg/h) or LVHF (35 ml/kg/h).
• Vasopressor dose was adjusted to maintain mean arterial pressure (MAP) > 65 mmHg.

Main Results:

• Mean norepinephrine dose decreased significantly faster in the HVHF group within 24 hours (P = 0.004).
• Lactate levels and PaO(2)/FiO(2) ratio did not differ between groups.
• Urine output showed a trend towards increase in the HVHF group (P = 0.059), but logistic organ dysfunction (LOD) scores were similar.

Conclusions:

• HVHF effectively reduced vasopressor requirements in septic shock patients with renal failure.
• A trend towards increased urine output was observed with HVHF.
• Larger trials are necessary to confirm these findings and assess impact on survival.