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Abstract
BackgroundIn critically ill children, in-line microfilters may reduce the incidence of the systemic inflammatory response syndrome (SIRS), the overall complication and organ dysfunction rate. No data on the use of in-line microfilters exist in critically ill adults.MethodsIn this prospective, randomized, controlled open-label study, we evaluated the influence of in-line microfilters on systemic immune activation in 504 critically ill adults with a central venous catheter in place and an expected length of stay in the intensive care unit >24 h. Patients were randomized to have in-line microfilters placed into all intravenous lines (intervention group) or usual care (control group). The primary endpoint was the number of intensive care unit days with SIRS. Secondary endpoints were the incidence of SIRS, SIRS criteria per day, duration of invasive mechanical ventilation, intensive care unit length of stay, the incidence of acute lung injury, maximum C-reactive protein, maximum white blood cell count, incidence of new candida and/or central-line-associated bloodstream infections, incidence of new thromboembolic complications, cumulative insulin requirements and presence of hyper- or hypoglycemia.ResultsThe study groups did not differ in any baseline variable. There was no difference in the number of days in the intensive care unit with SIRS between microfilter and control patients [2 (0.8–4.7) vs. 1.8 (0.7–4.4), p = 0.62]. Except for a higher incidence of SIRS in microfilter patients (99.6 vs. 96.8 %, p = 0.04), no difference between the groups was observed in any secondary outcome parameter. Results did not change when only patients with an intensive care unit length of stay of greater than 7 days were included in the analysis. The rate of adverse events was comparable between microfilter and control patients. In two patients allocated to the microfilter group, the study intervention was discontinued for technical reasons. Use of in-line microfilters was associated with additional costs.ConclusionsThe use of in-line microfilters failed to modulate systemic inflammation and clinical outcome parameters in critically ill adults.Trial registration: Clinical Trials NCT01534390
Highlights
In critically ill children, in-line microfilters may reduce the incidence of the systemic inflammatory response syndrome (SIRS), the overall complication and organ dysfunction rate
Patients and randomization All critically ill patients older than 18 years with an expected length of stay in the intensive care unit (ICU) > 24 h and a central venous catheter in place or one placed within the first 24 h after ICU admission were eligible for study entry
There was no difference in the number of days in the ICU with SIRS between microfilter and control patients
Summary
In-line microfilters may reduce the incidence of the systemic inflammatory response syndrome (SIRS), the overall complication and organ dysfunction rate. Particulate contamination arises from manufacture, packaging and transport of solutions and drugs [3] or drug incompatibility reactions [4]. These particles may stimulate the immune system and cause organ damage, aggravating the underlying disease [5]. As a pro-inflammatory state commonly occurs during critical illness [6], patients in the intensive care unit (ICU) may be vulnerable to particle infusion and additional immune stimulation [3]. Systemic stimulation of the immune system in critically ill patients is a risk factor for multiple organ dysfunction and death [6]. Mechanisms of particle-induced organ damage are a mechanical blockage of microvessels [3], the activation of platelets and neutrophilic granulocytes with the generation of occlusive micro-thrombi [3] and the formation of foreign body granulomas [7,8,9]
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