Alessandro Putzu1, Ming-Xing Fang2,3, Martina Boscolo Berto4, Alessandro Belletti2, Luca Cabrini2, Tiziano Cassina4, Giovanni Landoni2,5. 1. Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, Lugano, Switzerland - alessandroputzu@ymail.com. 2. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Department of Intensive Care Medicine, Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China. 4. Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, Lugano, Switzerland. 5. Vita-Salute San Raffaele University, Milan, Italy.
Abstract
INTRODUCTION: Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. EVIDENCE ACQUISITION: Online databases were searched for pertinent studies up to March 2017. We included randomized-controlled trials on the use of CVVH as blood purification technique in comparison to conventional therapy in adult patients with severe sepsis/septic shock or ARDS but no acute kidney injury needing renal replacement therapy. EVIDENCE SYNTHESIS: Eleven studies and 679 patients were included in the analysis. Patients who received CVVH had significantly lower mortality compared to conventional therapy (96 of 351 [27.35%] patients in the CVVH group vs. 129 of 328 [39.33%] in the conventional therapy group, OR=0.58 [95% CI: 0.42, 0.81], P=0.002, I2=10%, number needed to treat: 8) at longest follow-up available. CONCLUSIONS: Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.
INTRODUCTION: Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. EVIDENCE ACQUISITION: Online databases were searched for pertinent studies up to March 2017. We included randomized-controlled trials on the use of CVVH as blood purification technique in comparison to conventional therapy in adult patients with severe sepsis/septic shock or ARDS but no acute kidney injury needing renal replacement therapy. EVIDENCE SYNTHESIS: Eleven studies and 679 patients were included in the analysis. Patients who received CVVH had significantly lower mortality compared to conventional therapy (96 of 351 [27.35%] patients in the CVVH group vs. 129 of 328 [39.33%] in the conventional therapy group, OR=0.58 [95% CI: 0.42, 0.81], P=0.002, I2=10%, number needed to treat: 8) at longest follow-up available. CONCLUSIONS: Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.
Authors: Faeq Husain-Syed; Zaccaria Ricci; Daniel Brodie; Jean-Louis Vincent; V Marco Ranieri; Arthur S Slutsky; Fabio Silvio Taccone; Luciano Gattinoni; Claudio Ronco Journal: Intensive Care Med Date: 2018-07-24 Impact factor: 17.440
Authors: Michael Joannidis; Lui G Forni; Sebastian J Klein; Patrick M Honore; Kianoush Kashani; Marlies Ostermann; John Prowle; Sean M Bagshaw; Vincenzo Cantaluppi; Michael Darmon; Xiaoqiang Ding; Valentin Fuhrmann; Eric Hoste; Faeq Husain-Syed; Matthias Lubnow; Marco Maggiorini; Melanie Meersch; Patrick T Murray; Zaccaria Ricci; Kai Singbartl; Thomas Staudinger; Tobias Welte; Claudio Ronco; John A Kellum Journal: Intensive Care Med Date: 2019-12-09 Impact factor: 17.440