Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock

Abstract

Objective: The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs). Design: Prospective, intention-to-treat. Setting: General ICU of a tertiary care, non-teaching, 400-bed, city hospital. Patients and participants: Twelve consecutive mechanically ventilated septic shock patients, with or without concomitant acute renal failure (ARF). Intervention: A median of 10 consecutive sessions (prescribed treatment time: 10 h/session; delivered duration: 8.43±1.37 h/min) of coupled plasmafiltration-adsorption for each patient. Measurements and results: Mean arterial pressure (77.2±12.5 [CI 95%; 74.5-79.8] vs. 83.3±14.1 [CI 95%; 80.3-86.3] mm Hg; [p<0.001]), cardiac index (4.03±0.89 [CI 95%; 3.83-4.22] vs. 3.46±0.82 [CI 95%; 3.28-3.64] L/m2/min; [p<0.001]), systemic vascular resistance index (1,388±496 [CI 95%; 1,278-1,497] vs. 1,753±516 [CI 95%; 1,639-1,867] dynes x s/cm5; [p<0.001]), PO2/FIO2 ratio (204±87 [CI 95%; 185-223] vs. 238±82 [CI 95%; 220-256]; [p<0.001]), significantly improved during 100 global treatments (pre- vs. post-treatment values). Intra-thoracic blood volume and extra-vascular lung water did not change across treatments. Vasopressor requirement was reduced: norepinephrine decrease from an infusion rate of 0.13±0.07 (CI 95%; 0.06-0.16) to 0 γ/kg/min after a mean of 5.3±2.7 sessions. C reactive protein (CRP) significantly decreased (from 29.3±7.3 vs. 7.9±4.8; p<0.0001) during treatment. Survival was 90% at day 28 and 70% at day 90. Conclusion: Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.