Abstract
BackgroundThe potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing.MethodsThis single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay.ResultsComparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P < 0.01) and hospital stay (14.0 (9.2–22.2) vs 14.8 (10.0–26.8) days; P = 0.01) were reduced. Rate of severe vasoplegia (21.0% vs 19.6%; P > 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts.ConclusionsIn-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients.Trial registrationThe study was registered at ClinicalTrials.gov (number: NCT02281604).
Highlights
The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear
In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients
The matched cohorts with n = 1506 patients each showed no significant differences in the baseline characteristics except a higher age, Simplified Acute Physiology Score (SAPS) II score, and delirium score in the finer filter cohort (Table 1)
Summary
The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. The German Society of Anaesthesiology and Intensive Care Medicine and the Berufsverband Deutscher Anästhesisten both strongly suggest the use of particle filters with size always adapted to the type of fluid or drug (chosen as small as possible due to the suspected harmful effects of very small particles in the range of 2–100 μm) [20]. Organisations such as the PDA (Parenteral Drug Association) Europe offer regular training for physicians to transfer actual knowledge about potential harmful effects of particles for patients and participate actively in research activities on particles in parenteral drugs. The evidence on the benefits for adult intensive care patients is still unclear
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