Das endgültige Aus für „nicht-renale“ Indikationen der Hämofiltration?

Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: A randomized controlled trial.

Payen D, Mateo J, Cavaillon JM, et al.                                                                                                                Crit Care Med 2009; 37:803-10

Department of Anesthesiology and Critical Care Medicine, Lariboisière Hospital, University Paris, Paris, France

OBJECTVIE: The impact of continuous venovenous hemofiltration on sepsis-induced multiple organ failure severity is controversial. We sought to assess the effect of early application of hemofiltration on the degree of organ dysfunction and plasma cytokine levels in patients with severe sepsis or septic shock.
DESIGN: Prospective, randomized, open, multicenter study setting 12 French intensive care units.
PATIENTS: A total of 80 patients were enrolled within 24 hours of development of the first organ failure related to a new septic insult.
INTERVENTIONS: Patients were randomized to group 1 (HF), who received hemofiltration (25 mL/kg/hr) for a 96-hour period or group 2 (C), who were managed conventionally.
MEASUREMENTS AND MAIN RESULTS: The primary end point was the number, severity and duration of organ failures during 14 days, as evaluated by the Sepsis-Related Organ Failure Assessment Score, on an intention-to-treat analysis. Strict guidelines were provided to perform continuous hemofiltration under the same conditions and bearing the same objectives in all centers. Because of inclusion stagnation, the trial was discontinued after an interim analysis by which time 76 patients had been randomized. The number and severity of organ failures were significantly higher in the HF group (p < 0.05). No modifications in plasma cytokine levels could be detected.
CONCLUSION: These data suggest that early application of standard continuous venovenous hemofiltration is deleterious in severe sepsis and septic shock. This study does not rule out an effect of high-volume hemofiltration (>35 mL/kg/hr) on the course of sepsis.