Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, Lugano, Switzerland -
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Minerva Anestesiol. 2017 Aug;83(8):867-877. doi: 10.23736/S0375-9393.17.11946-2. Epub 2017 Jun 12.
Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings.
Online databases were searched for pertinent studies up to March 2017. We included randomized-controlled trials on the use of CVVH as blood purification technique in comparison to conventional therapy in adult patients with severe sepsis/septic shock or ARDS but no acute kidney injury needing renal replacement therapy.
Eleven studies and 679 patients were included in the analysis. Patients who received CVVH had significantly lower mortality compared to conventional therapy (96 of 351 [27.35%] patients in the CVVH group vs. 129 of 328 [39.33%] in the conventional therapy group, OR=0.58 [95% CI: 0.42, 0.81], P=0.002, I2=10%, number needed to treat: 8) at longest follow-up available.
Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.
严重炎症状态，如严重脓毒症/感染性休克和急性呼吸窘迫综合征（ARDS），与高发病率和死亡率相关。我们进行了一项荟萃分析，评估连续静脉-静脉血液滤过（CVVH）作为血液净化方法在这些情况下是否降低死亡率。
在线数据库检索了截至 2017 年 3 月的相关研究。我们纳入了比较 CVVH 与常规治疗在成人严重脓毒症/感染性休克或 ARDS 但无需要肾脏替代治疗的急性肾损伤患者中应用的随机对照试验。
11 项研究和 679 例患者纳入分析。与常规治疗相比，接受 CVVH 的患者死亡率显著降低（CVVH 组 351 例患者中有 96 例[27.35%]，常规治疗组 328 例患者中有 129 例[39.33%]，OR=0.58[95%CI：0.42, 0.81]，P=0.002，I2=10%，需要治疗的人数：8）在最长随访期。
总体而言，低质量证据表明，在脓毒症或 ARDS 患者中进行 CVVH 血液净化可能与死亡率显著降低相关。但目前证据仍不足以支持 CVVH 有益的明确结论。需要进一步开展高质量、充分针对死亡率的随机对照试验，以明确 CVVH 对这些疾病的影响。
