• Yosuke Matsumura, Shigeto Oda, Tomohito Sadahiro, Masataka Nakamura, Yo Hirayama, Eizo Watanabe, Ryuzo Abe, Taka-Aki Nakada, Yoshihisa Tateishi, Taku Oshima, Koichiro Shinozaki, and Hiroyuki Hirasawa.
• Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. yousuke_jpn4035@yahoo.co.jp
• Int J Artif Organs. 2012 Jan 1;35(1):3-14.

PurposeCytokines play pivotal roles in the pathophysiology of severe sepsis/septic shock, and continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) removes cytokines efficiently and continuously, mainly through adsorption to a hemofilter membrane. The aim of this study was to investigate the clinical efficacy of enhanced intensity PMMA-CHDF in treating refractory septic shock.MethodsSeventy-two septic shock patients admitted to the intensive care unit (ICU) underwent critical care including PMMA-CHDF. We employed enhanced intensity PMMA-CHDF to improve the cytokine removal rate by increasing the hemofilter membrane area in 10 refractory septic shock patients (enhanced intensity group, EI group; 2 extracorporeal CHDF circuits using the hemofilter with a larger membrane area of 2.1 m2). Other patients undergoing conventional PMMA-CHDF and matched for severity with the EI group, comprised a matched conventional group (MC group; using a PMMA membrane hemofilter with a membrane area of 1.0 m2; n=15). The case-control comparison was performed between the 2 groups.ResultsEnhanced intensity PMMA-CHDF significantly increased mean arterial pressure by 23.8% in 1 hour (p=0.037), decreased the blood lactate level by 28.6% in 12 hours (p=0.006), and reduced blood IL-6 level in 24 hours (p=0.005). The ICU survival rate in the EI group was significantly better than that in the MC group (60% vs. 13.3%, p=0.028).ConclusionEnhanced intensity PMMA-CHDF may improve hemodynamics and survival rate in patients with refractory septic shock.

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