• J H Reeves and W W Butt.
• Intensive Care Unit, Royal Childrens Hospital, Parkville, Victoria, Australia.
• Intensive Care Med. 1995 Jun 1; 21 (6): 500-4.

ObjectiveTo review the safety and efficacy of haemofiltration and plasmafiltration in children with severe sepsis.DesignRetrospective case notes analysis.SettingUniversity Paediatric Intensive Care Unit.PatientsAll children admitted to the intensive care unit between November 1985 and May 1992 with a primary diagnosis of severe sepsis who also received blood filtration therapy.InterventionsContinuous haemofiltration (HF) 18 patients; continuous haemofiltration and plasmafiltration (PF) 9 patients.Measurements And Results27 children with sepsis-induced MOSF, median age 26.6 months (range 0.33-185), median weight 12 kg (range 2.5-58), mean PRISM score 19.4 (SD 8.6), mean number of organs failing 2.78 (SD 0.9) received filtration for a median duration of 36 hours (range 2-145). Eight (30%) survived (HF 5/18, PF 3/9). There was no significant difference in the demographic features between the HF group and the PF group and no difference in mortality. The two groups were pooled to assess the effect of commencement of filtration on clinical wellbeing. Arterial blood gases, electrolytes, full blood examination, ventilator settings and doses of inotropes were recorded immediately prior to commencement of filtration and 18 h after commencement. Serum anion gap and osmolality were calculated using conventional formulae. There were no significant changes in the level of cardiorespiratory support, or biochemical markers of severity following commencement of filtration. Platelet count fell 32% (p = 0.029) but no bleeding was encountered. No severe complications were observed during 1222 h of filtration. No bleeding or infection was observed at the site of cannulation. One child developed haemodynamic instability following commencement of plasmafiltration necessitating abandonment of the procedure.ConclusionHaemofiltration or plasmafiltration can be performed safely in children with severe sepsis but their effect on outcome remains unknown.

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