26 In-Line Filtration Reduces Sirs in Critically Ill Children

Abstract

Objectives: Sepsis, systemic inflammatory response syndrome (SIRS) or organ failure of ten complicate the clinical course on an intensive care unit. Particulate contamination of infusion solution may con-tribute to the clinical deterioration of these patients. Particles have been shown to induce thrombogenesis, deterioration of microcircu-lation and modulation of immunoresponse. The use of in-line filtration with micro-filters almost completely prevents particulate infusion.We assessed the effect of in-line filtration on the reduction of major complications in critically ill children (Clinical Trials.gov ID NCT 00209768). Patients and methods: In a randomised, prospective trial 807 paedi-atric patients admitted to the interdisciplinary PICU of a tertiary university hospital were assigned to either control or interventional group, the latter receiving in-line filtration (infusion filter Pall ELD96LLCE/NOE96E, Braun Intrapur Lipid/ Intrapur Neonat Lipid) throughout whole infusion therapy. Prior to this study, infusion reg-iment was optimised to prevent precipitation and incompatibilities of solutions and drugs. Primary objectives included a reduction in the incidence of sepsis, thrombosis, systemic inflammatory response syndrome (SIRS), organ failure (liver, lung, kidney, circulation) and mortality. Results: 807 children (343 female, 464 male) with a heterogeneous background of underlying diagnoses and a Gaussian distribution to either control (406 patients) or in-line filtration group (401 patients) were included. According to the study criteria a significant reduction in the incidence of SIRS for the interventional group (95% CI, 145 vs. 200 patients, P < 0.001) was evident. No differences were demon-strated for the occurrence of sepsis, thrombosis, organ failure (liver, lung, kidney, circulation) or mortality between the control and interventional group. Conclusion: The occurrence of SIRS of ten complicates the treatment in intensive care medicine. Inline-filtration is most effective reducing the incidence of SIRS and of fers a novel therapeutic option.