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Sustained High-Efficiency Daily Diafiltration Using a Mediator-Adsorbing Membrane (SHEDD-fA) in the Treatment of Patients with Severe Sepsis.
MedLine Citation:
PMID:  21865790     Owner:  NLM     Status:  In-Data-Review    
Sustained high-efficiency daily diafiltration using a mediator-adsorbing membrane (SHEDD-fA) is an effective, intensive modality for sepsis treatment. Here we describe the effectiveness of SHEDD-fA, which makes the best use of three principles: dialysis, filtration and adsorption, for mediator removal in the treatment of severe sepsis. SHEDD-fA was initiated after adequate fluid resuscitation and catecholamine support had been provided. A large (2.1 m(2)) polymethylmethacrylate membrane dialyzer was placed in the blood circuit. Operation conditions were as follows: blood flow rate 150 ml/min, filtration rate 1,500 ml/h (post-dilution), and dialysate flow rate 300-500 ml/min over 8-12 h daily. 55 consecutive patients with severe sepsis were studied. The following results were obtained: pressure catecholamine index significantly decreased at 3 h after initiation of septic shock, PaO(2)/F(IO2) significantly increased at 1 h after initiation of septic acute respiratory distress syndrome, a significant decrease in interleukin (IL)-6 level for 3 days was observed, and IL-6 was effectively adsorbed in one pass through the filter. The average sequential organ failure assessment score of patients was 10.1 and the mortality at 28 days was 16.4% (46 survived, 9 died). Because SHEDD-fA is an intensive and high-efficiency modality, removal of useful drugs or nutrients may be observed. Despite the fact that removal of useful substances cannot be ignored, we believe that an appropriate stage or timing can be identified so that we can avoid a vicious cycle and use blood purification with effective diffusion, filtration and adsorption. We demonstrate that SHEDD-fA may be an effective, intensive modality for the treatment of patients with severe sepsis and is a possible modality for cytokine modulation therapy.
Osamu Nishida; Tomoyuki Nakamura; Naohide Kuriyama; Yoshitaka Hara; Miho Yumoto; Yasuyo Shimomura; Kazuhiro Moriyama
Publication Detail:
Type:  Journal Article     Date:  2011-08-08
Journal Detail:
Title:  Contributions to nephrology     Volume:  173     ISSN:  1662-2782     ISO Abbreviation:  Contrib Nephrol     Publication Date:  2011  
Date Detail:
Created Date:  2011-08-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513582     Medline TA:  Contrib Nephrol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  172-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 S. Karger AG, Basel.
Department of Anesthesiology and Critical Care Medicine, Fujita Health University, School of Medicine, Aichi, Japan.
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