Systemic Inflammatory Response Syndrome Clinical Trial
Official title:
High Cut-off Continuous Venovenous Hemodialysis (CVVHD) to Improve Hemodynamic Stability and Organ Function Scores in Patients Treated for Acute Renal Failure After Systemic Inflammatory Response Syndrome (SIRS)/Septic Shock
This study will assess the influence of the High Cut-Off (HCO) CVVHD treatment on the disease progression in septic patients. The primary aim of the study is to evaluate whether HCO CVVHD leads to a significant improvement of the hemodynamic status (mean arterial pressure, vasopressor requirements) in septic patients in comparison to CVVHD treatment with conventional high-flux filters. For the HCO-group the investigators expect a 50% lower dosage of vasopressors needed to maintain an adequate organ perfusion.
Severe sepsis is a devastating disorder that results from a complex host response to insult
after infection. Despite advances in intensive care technologies sepsis remains an important
and life-threatening problem. Sepsis is the most common cause of death in the intensive care
unit.
Local or systemic release of bacteria-derived compounds, leading to the production of
proinflammatory cytokines, induce systemic inflammatory reactions in septic patients.
Continuous renal replacement therapies (CRRT) such as hemodialysis (CVVHD), hemofiltration
(CVVH) or hemodiafiltration (CVVHDF) with conventional high-flux membranes allow to control
fluid and electrolyte balance, and to improve the hemodynamic status of the patients.
However, conventional high flux membranes have a limited permeability for sepsis-associated
mediators with molecular weights in the range of 15.000 to 60.000 Da.
A promising approach to enhance the mediator removal is to use membranes having larger pores
and permeability characteristics than those currently used in CRRT.
For that purpose a High Cut-Off (HCO) membrane has been developed and is manufactured by
Gambro Research.After demonstrating the safety as well as the cytokine removal effectiveness
in a clinical pilot study this study will assess the influence of the HCO treatment on the
disease progression in septic patients.
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