[A comparison of high versus standard-volume hemofiltration in critically ill children with severe sepsis].

Objective: High-volume hemofiltration (HVHF) is an potential therapy for the treatment of sverve sepsis in intensive care unit, but little information is avialible in children. The aim of our study was to evaluate the effects of HVHF compared with standard-volume continuous veno-venous hemofiltration (CVVH) for critically ill children with severe sepsis, and to evaluate the feasibility and tolerance.

Methods: A single-center prospective trial was performed on the data of critically ill children with sverve sepsis, who were treated with 48hours HVHF (effluent rate 50 - 70 ml . kg-1 . h-1) versus more than 48hours CVVH(effluent rate 35 ml . kg-1 . h-1) from May, 2009 to April, 2014 in Shanghai Children's Hospital, Shanghai Jiao Tong University. Biomarkers and clinical outcomes were compared between the HVHF and standard-volume CVVH groups included 28-day mortality, lengths of PICU stays, vasopressor dose reduction and adverse events.

Results: A total of 72 critically ill patients with severe sepsis comfirmed less than 72 hours were enrolled. male 42 cases (58. 3%) and female 30 cases (41. 7%) , median age was 56 months(range from 3 to 168 months). Patients were randomized to either HVHF(n =34) at 50 - 70 ml . kg-1 . h-1 or standard-volume CVVH (n = 38). There were no significant difference either PRISM III score or pediatric critical illness score between HVHF and standard-volume CVVH group (P > 0. 05). Death occurred in 24 cases, the total mortality was 33. 3%. Mortality at 28 days was lower than expected but not statistically significant differences HVHF 29.4% comnared with standard-volume CVVH 36.8% (χ2 = 0. 45, P = 0. 50). After blood hemofiltration therapy the dosage of heparin in HVHF group are lower than CVVH group (P <0. 05) . Complications of hypernatremia, alkali imbalance and glucose abnormalities in HVHF group is higher than that of standard-volume CVVH group (P <0. 05 or P <0. 01).

Conclusions: Compared with standard -volume CVVH, HVHF is safe on severe sepsis in children and is trend to reduce the case fatality rate. But still expect the multi-center and larger sample study for evaluation the 28 days mortality in pediatric critically ill with severe sepsis.