High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial

Critical Care

卷:21

for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators¹  Marlene Albrecht²  Daniel M. Caruso²  Kevin K. Chung³  Robert F. Mullins⁴  Amy M. Sprague⁴  Michael J. Mosier⁵  Marcia Halerz⁵  Elsa C. Coates⁶  Sandra L. Taylor⁷  David J. Smith⁸  Rachel A. Karlnoski⁸  Angela L. Arnold-Ross⁹  William L. Hickerson⁹  Brett D. Arnoldo¹⁰  Steven E. Wolf¹⁰  Agnes M. Burris¹⁰ 

[1] ;

[2] Arizona Burn Center Maricopa Integrated Health Systems;

[3] Brooke Army Medical Center;

[4] Doctors Hospital Joseph M. Still Burn Center;

[5] Loyola University Medical Center;

[6] United States Army Institute of Surgical Research;

[7] University of California Davis;

[8] University of South Florida Tampa General Hospital;

[9] University of Tennessee Firefighters’ Regional Burn Center;

[10] University of Texas Southwestern Medical Center;

关键词: High-volume hemofiltration;    Burns;    Septic shock;    Acute kidney injury;    Randomized controlled trial;    Multicenter;   

DOI  :  10.1186/s13054-017-1878-8

来源: DOAJ

【 摘 要 】

Abstract Background Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. Methods We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices. Results During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups. Conclusions HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined. Trial registration Clinicaltrials.gov NCT01213914 . Registered 30 September 2010.

【 授权许可】

Unknown