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Effect of high-volume hemofiltration on children with sepsis

Botao Ning1, Sheng Ye2, Yi Lyu3

  • 1Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.

Translational Pediatrics
|June 2, 2020
PubMed

Insights

High-volume hemofiltration (HVHF) improved sepsis outcomes in children. This treatment enhanced oxygenation, reduced inflammatory markers, and lowered mortality risk compared to standard continuous renal replacement therapy (CRRT).

Area of Science:

  • Pediatric Intensive Care
  • Nephrology
  • Critical Care Medicine

Background:

  • Sepsis presents a significant challenge in pediatric intensive care units (PICUs), often leading to poor prognoses.
  • Continuous renal replacement therapy (CRRT) is a standard treatment, but its efficacy in pediatric sepsis requires further evaluation.
  • High-volume hemofiltration (HVHF) is an alternative modality for fluid management and toxin removal.

Purpose of the Study:

  • To compare the effectiveness of routine CRRT versus HVHF in pediatric patients diagnosed with sepsis.
  • To evaluate the impact of HVHF on key clinical and biochemical markers of sepsis severity and organ function.
  • To assess the influence of HVHF on mortality rates in pediatric sepsis patients.

Main Methods:

  • A prospective, randomized, controlled, open-label trial involving 47 children with sepsis.
  • Patients were assigned to either routine CRRT (22 patients) or HVHF (25 patients) within 6 hours of sepsis diagnosis.
  • Key parameters monitored included oxygenation index, serum creatinine, urea, lactate, inflammatory cytokines (IL-6, IL-10, TNF-α), PRISM III score, and 28-day mortality.

Main Results:

  • HVHF significantly improved the oxygenation index and arterial lactate levels at 48 and 72 hours post-treatment compared to CRRT.
  • Serum creatinine, urea, IL-6, IL-10, TNF-α, and PRISM III scores were significantly ameliorated in the HVHF group after 72 hours.
  • While HVHF showed marked improvements in sepsis markers, there was no statistically significant difference in 28-day mortality between the HVHF and CRRT groups.

Conclusions:

  • High-volume hemofiltration (HVHF) demonstrates potential as an effective treatment strategy for pediatric sepsis.
  • HVHF offers significant benefits in improving organ function and reducing inflammatory responses in children with sepsis.
  • Further research is warranted to explore the impact of HVHF on long-term outcomes and mortality in pediatric sepsis.
Abstract

Keywords:
Childrenefficacyhigh-volume hemofiltrationsepsis

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