Related Experiment Videos
Blood filtration in children with severe sepsis: safe adjunctive therapy
1Intensive Care Unit, Royal Childrens Hospital, Parkville, Victoria, Australia.
Insights
This study reviewed blood filtration therapies for pediatric severe sepsis. While haemofiltration and plasmafiltration were safely administered, their impact on patient survival and clinical outcomes requires further investigation.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care
Background:
- Severe sepsis in children often leads to multiple organ failure.
- Blood filtration techniques like haemofiltration and plasmafiltration are explored for critically ill pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of haemofiltration (HF) and plasmafiltration (PF) in children diagnosed with severe sepsis.
- To assess the impact of these blood filtration therapies on clinical parameters and patient outcomes.
Main Methods:
- A retrospective analysis of case notes was conducted.
- The study included children admitted to a University Paediatric Intensive Care Unit with severe sepsis who underwent blood filtration therapy.
- Data from 27 children (18 receiving HF, 9 receiving PF) were analyzed.
Main Results:
- Eight out of 27 children (30%) survived the severe sepsis and multiple organ failure.
- No significant differences in demographic features or mortality were observed between the HF and PF groups.
- While generally safe with no severe complications reported, a 32% fall in platelet count was noted, and one patient experienced hemodynamic instability during plasmafiltration.
Conclusions:
- Haemofiltration and plasmafiltration appear to be safe procedures for pediatric patients with severe sepsis.
- The current data do not establish a clear benefit of these filtration methods on patient survival or clinical improvement in severe sepsis.
Objective:
To review the safety and efficacy of haemofiltration and plasmafiltration in children with severe sepsis.
Design:
Retrospective case notes analysis.
Setting:
University Paediatric Intensive Care Unit.
Patients:
All children admitted to the intensive care unit between November 1985 and May 1992 with a primary diagnosis of severe sepsis who also received blood filtration therapy.
Interventions:
Continuous haemofiltration (HF) 18 patients; continuous haemofiltration and plasmafiltration (PF) 9 patients.
Measurements And Results:
27 children with sepsis-induced MOSF, median age 26.6 months (range 0.33-185), median weight 12 kg (range 2.5-58), mean PRISM score 19.4 (SD 8.6), mean number of organs failing 2.78 (SD 0.9) received filtration for a median duration of 36 hours (range 2-145). Eight (30%) survived (HF 5/18, PF 3/9). There was no significant difference in the demographic features between the HF group and the PF group and no difference in mortality. The two groups were pooled to assess the effect of commencement of filtration on clinical wellbeing. Arterial blood gases, electrolytes, full blood examination, ventilator settings and doses of inotropes were recorded immediately prior to commencement of filtration and 18 h after commencement. Serum anion gap and osmolality were calculated using conventional formulae. There were no significant changes in the level of cardiorespiratory support, or biochemical markers of severity following commencement of filtration. Platelet count fell 32% (p = 0.029) but no bleeding was encountered. No severe complications were observed during 1222 h of filtration. No bleeding or infection was observed at the site of cannulation. One child developed haemodynamic instability following commencement of plasmafiltration necessitating abandonment of the procedure.
Conclusion:
Haemofiltration or plasmafiltration can be performed safely in children with severe sepsis but their effect on outcome remains unknown.