Prolonged intermittent high-volume hemofiltration in severe septic shock

Abstract

Background:

Septic shock is a life-threatening condition. Prolonged intermittent high-volume hemofiltration (HVHF) has been used as a hemodynamic support and immunomodulation strategy for patients with severe septic shock.

Methods:

We studied a retrospective cohort of patients with severe septic shock who received HVHF, evaluating the response to this therapy and the factors associated with mortality.

Results:

We analyzed 63 patients with severe septic shock (age 62.8 ± 13.8 years, 57.1% female, maximum SOFA 16.1 ± 3.4). Mortality was significantly associated with male sex, medical pathology at admission, chronic critical illness condition, elevated SOFA, and high doses of norepinephrine at the end of HVHF. Patients whose HVHF was performed within 24 h after surgery had lower mortality (p = 0.025). Norepinephrine dose decreased significantly with HVHF (p = 0.038). Mortality in our study was 73%, significantly lower than the predicted mortality by SOFA score: 80%–90% (p = 0.008).

Conclusion:

HVHF could facilitate the management of critically ill patients with severe septic shock, especially women and surgical patients. It would allow for immunomodulation and hemodynamic support, providing time to control infection and improve the poor prognosis for these patients.