Morgera Stanislao, Rocktäschel Jens, Haase Michael, Lehmann Christian, von Heymann Christian, Ziemer Sabine, Priem Friedrich, Hocher Berthold, Göhl Hermann, Kox Wolfgang J, Buder Hans-W, Neumayer Hans-H
Department of Nephrology, Charité, Humboldt University of Berlin, Schumannstrasse 20-21, 10098, Berlin, Germany,
Intensive Care Med. 2003 Nov;29(11):1989-95. doi: 10.1007/s00134-003-2003-9. Epub 2003 Sep 3.
High permeability hemofiltration (HP-HF) is a new renal replacement modality designed to facilitate the elimination of cytokines in sepsis. Clinical safety data on this new procedure is still lacking. This study investigates the effects of HP-HF on the protein and coagulation status as well as on cardiovascular hemodynamics in patients with septic shock. In addition, the clearance capacity for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) is analyzed.
Prospective, single-center pilot trial.
University hospital.
Sixteen patients with multiple organ failure (MOF) induced by septic shock were studied.
Patients were treated by intermittent high permeability hemofiltration (iHP-HF; nominal cut-off point: 60 kilodaltons). Intermittent HP-HF was performed over 5 days for 12 h per day and alternated with conventional hemofiltration.
Intermittent HP-HF proved to be a safe hemofiltration modality in regard to cardiovascular hemodynamics and its impact on the coagulation status. However, transmembrane protein loss occurred and cumulative 12-h protein loss was 7.60 g (IQR: 6.2-12.0). The filtration capacity for IL-6 was exceptionally high. The IL-6 sieving coefficient approximated 1 throughout the study period. The total plasma IL-6 burden, estimated by area under curve analysis, declined over time ( p<0.001 vs baseline). The TNF-alpha elimination capacity was poor.
High permeability hemofiltration is a new approach in the adjuvant therapy of sepsis that facilitates the elimination of cytokines. HP-HF alternating with conventional hemofiltration is well tolerated. Further studies are needed to analyze whether HP-HF is able to mitigate the course of sepsis.
高通透性血液滤过（HP-HF）是一种旨在促进脓毒症中细胞因子清除的新型肾脏替代治疗方式。关于这一新型治疗方法的临床安全性数据仍然缺乏。本研究调查了HP-HF对感染性休克患者蛋白质和凝血状态以及心血管血流动力学的影响。此外，还分析了其对白介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的清除能力。
前瞻性单中心试点试验。
大学医院。
对16例由感染性休克引起多器官功能衰竭（MOF）的患者进行了研究。
患者接受间歇性高通透性血液滤过（iHP-HF；标称截留分子量：60千道尔顿）治疗。间歇性HP-HF持续5天，每天进行12小时，并与传统血液滤过交替进行。
就心血管血流动力学及其对凝血状态的影响而言，间歇性HP-HF被证明是一种安全的血液滤过方式。然而，发生了跨膜蛋白丢失，12小时累计蛋白丢失量为7.60 g（四分位间距：6.2 - 12.0）。IL-6的滤过能力极高。在整个研究期间，IL-6的筛系数接近1。通过曲线下面积分析估计的血浆IL-6总负荷随时间下降（与基线相比，p<0.001）。TNF-α的清除能力较差。
高通透性血液滤过是脓毒症辅助治疗中的一种新方法，有助于细胞因子的清除。HP-HF与传统血液滤过交替进行耐受性良好。需要进一步研究来分析HP-HF是否能够减轻脓毒症的病程。
