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A Randomized Comparative Crossover Study to Assess the Affect on IL-6 Clearance and Circuit Life of Varying Pre-dilution Volume CVVH

Author: Qin
Tutor: HuZhenJie；ZhuGuiJun
School: Hebei Medical University
Course: Emergency Medicine
Keywords: Continuous venovenous hemofiltration High- volume hemofiltration Severe systemic infection Interleukin-6 Before dilution Screening factor Loop Life
CLC: R459.7
Type: Master's thesis
Year: 2010
Downloads: 39
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Abstract

Objective: With the development of biomedical technology, blood purification (Blood Purification, BP) gradually been applied beyond the field of renal replacement therapy, especially in critically ill patients. Inflammatory response in severe systemic infection (Severe Sepsis) and septic shock (Septic Shock) the occurrence and development plays a very important role, and be able to control excessive blood purifier inflammation. However, blood purification for removal of inflammatory mediators effect remains controversial. There are reports, high-volume hemofiltration (High-Volume Hemofiltration, HVHF) because of its ability to better removal of inflammatory mediators are used to treat septic shock. For continuous venovenous hemofiltration (Continuous Veno-Venous Hemofiltration, CVVH), under the replacement fluid complementary approaches can be divided into two kinds of treatment, pre-dilution and post-dilution. Blood is diluted before entering the filter prior to mixing with the replacement fluid flows through the filter to remove excess solutes and water. Then the blood is diluted directly into the ultrafiltration of solutes and water filters, added after the filter replacement fluid to prevent excessive water loss, to ensure loop stability. These two different ways with a significant difference for the solute removal, pre-dilution of the blood through a filter before being diluted with displacement fluid, result in the removal efficiency decreased while loop longer life. Previous studies have found that pre-dilution CVVH treatment will reduce the efficiency of removal of small molecules, or by increasing the blood flow ultrafiltration rate to compensate. To further explore the different pre-dilution CVVH proportion of patients with severe sepsis effects in critically ill patients, we developed a prospective cross-over study. Compare at 100% and 50% pre-dilution CVVH pre-dilution CVVH treatment process, the plasma interleukin -6 (IL-6) and the clearance rate loop Life. METHODS: From January 2009 to December 2009 period, we in patients with severe systemic infections conducted a prospective cross-over study, respectively 35ml/kg/h, 100% pre-dilution CVVH and 35ml/kg/h , 50% of the pre-dilution CVVH treatment. Comparison: one, each plasma IL-6 in the course of CVVH filter coefficients (Sieving Coefficient, SC) changes in trend over time; 2, IL-6 plasma between the two groups in the course of CVVH SC trends; 3, Compare filter plasma IL-6 levels before and after differences; 4, the difference in life were compared circuit. 1 50% pre-dilution CVVH treatment, two hours after the start of plasma IL-6 in SC (0.1017, interquartile range (IQR) 0.0794-0.1422), 6 - hour plasma IL-6 and SC (0.0988, IQR0.0669-0.1287) and 12 hours in plasma IL-6 and SC (0.0562, IQR0.0277-0.0906) compared to 6 hours over two hours showing a downward trend, but not statistically significant (p = 0.278); 12 小时 than six hours showing a significant decline trend, with a statistically significant (p = 0.009). 2 100% pre-dilution after two hours in the treatment group, plasma IL-6 in SC (0.0724, IQR0.0498-0.1140), 6 - hour plasma IL-6 and SC (0.0647, IQR0.0424-0.1128) and 12-hour plasma IL- 6 SC (0.0422, IQR0.0240-0.0922) compared to six hours over two hours without decreasing trend was not statistically significant (p = 0.822); 12 小时 than six hours showed a downward trend, but still no statistically significant (p = 0.136). 3 the same time between the two groups were not statistically different compared with SC (2 hours p = 0.079; 6 小时 p = 0.079; 12 小时 p = 0.308). 4 filters of plasma IL-6 concentrations (197.9pg/ml, IQR 121.4-278.7) higher than the front filter of plasma IL-6 concentrations (159.5pg/ml, IQR99.0-238.0), with a statistically significant difference (p = 0.000) . 5 100% pre-dilution loop group life (840min, 95% Confidence Interval (CI) 687-993) and 50% pre-dilution loop group life (840min, 95% CI 581-1099) there was no significant difference (Log Rank Test: χ2 = 0.04, p = 0.84). Conclusion: Increased pre-dilution ratio can be maintained for a long time to clear the IL-6 plasma convection efficiency; 50% pre-dilution CVVH in filtration fraction less than 20% under the conditions do not significantly affect circuit life.

A Randomized Comparative Crossover Study to Assess the Affect on IL-6 Clearance and Circuit Life of Varying Pre-dilution Volume CVVH

Abstract

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