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Influence of in-line microfilters on systemic inflammation in adult critically ill patients: a prospective,
Ilse Gradwohl-Matis1, Andreas Brunauer2, Daniel Dankl3
1Interdisciplinary Intensive Care Units, Department of Anesthesiology, Perioperative and General Intensive Care, Salzburg University Hospital and Paracelsus Private Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. I.Gradwohl-Matis@salk.at.
Insights
In-line microfilters did not reduce systemic inflammatory response syndrome (SIRS) days in critically ill adults. The intervention showed no clinical benefit and increased SIRS incidence, failing to improve outcomes.
Area of Science:
- Critical care medicine
- Intensive care unit management
- Infection control
Background:
- In-line microfilters are used in pediatric critical care to reduce complications.
- No data existed on microfilter use in critically ill adult patients.
- Systemic inflammatory response syndrome (SIRS) is a major concern in critically ill patients.
Purpose of the Study:
- To evaluate the effectiveness of in-line microfilters in reducing systemic immune activation in critically ill adults.
- To assess the impact of microfilters on SIRS incidence and other clinical outcomes.
- To determine if microfilters are beneficial for adult patients in the intensive care unit.
Main Methods:
- A prospective, randomized, controlled, open-label study involving 504 critically ill adults with central venous catheters.
- Patients were assigned to either in-line microfilters or usual care.
- Primary endpoint: intensive care unit days with SIRS. Secondary endpoints included SIRS incidence, mechanical ventilation duration, ICU length of stay, and infection rates.
Main Results:
- No significant difference in intensive care unit days with SIRS between microfilter and control groups.
- A higher incidence of SIRS was observed in the microfilter group (99.6% vs. 96.8%, p=0.04).
- No differences in secondary outcomes, adverse events, or infections were noted; microfilters incurred additional costs.
Conclusions:
- In-line microfilters did not modulate systemic inflammation or clinical outcomes in critically ill adults.
- The use of microfilters in this population did not provide clinical benefits.
- The intervention was associated with increased SIRS incidence and additional costs.
Background:
In critically ill children, in-line microfilters may reduce the incidence of the systemic inflammatory response syndrome (SIRS), the overall complication and organ dysfunction rate. No data on the use of in-line microfilters exist in critically ill adults.
Methods:
In this prospective, randomized, controlled open-label study, we evaluated the influence of in-line microfilters on systemic immune activation in 504 critically ill adults with a central venous catheter in place and an expected length of stay in the intensive care unit >24 h. Patients were randomized to have in-line microfilters placed into all intravenous lines (intervention group) or usual care (control group). The primary endpoint was the number of intensive care unit days with SIRS. Secondary endpoints were the incidence of SIRS, SIRS criteria per day, duration of invasive mechanical ventilation, intensive care unit length of stay, the incidence of acute lung injury, maximum C-reactive protein, maximum white blood cell count, incidence of new candida and/or central-line-associated bloodstream infections, incidence of new thromboembolic complications, cumulative insulin requirements and presence of hyper- or hypoglycemia.
Results:
The study groups did not differ in any baseline variable. There was no difference in the number of days in the intensive care unit with SIRS between microfilter and control patients [2 (0.8-4.7) vs. 1.8 (0.7-4.4), p = 0.62]. Except for a higher incidence of SIRS in microfilter patients (99.6 vs. 96.8 %, p = 0.04), no difference between the groups was observed in any secondary outcome parameter. Results did not change when only patients with an intensive care unit length of stay of greater than 7 days were included in the analysis. The rate of adverse events was comparable between microfilter and control patients. In two patients allocated to the microfilter group, the study intervention was discontinued for technical reasons. Use of in-line microfilters was associated with additional costs.
Conclusions:
The use of in-line microfilters failed to modulate systemic inflammation and clinical outcome parameters in critically ill adults.
Trial Registration:
Clinical Trials NCT01534390.
