High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury

A multicenter randomized controlled trial

for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. Methods: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices. Results: During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups. Conclusions: HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined. Trial registration: Clinicaltrials.gov NCT01213914. Registered 30 September 2010.

Original languageEnglish (US)
Article number289
JournalCritical Care
Volume21
Issue number1
DOIs
StatePublished - Nov 25 2017
Externally publishedYes

Fingerprint

Hemofiltration
Septic Shock
Acute Kidney Injury
Randomized Controlled Trials
Architectural Accessibility
Shock
Sepsis
Organ Dysfunction Scores
Burn Units
Renal Replacement Therapy
Survival
Multiple Organ Failure
Burns
Hemodynamics
Mortality
Population

Keywords

  • Acute kidney injury
  • Burns
  • High-volume hemofiltration
  • Multicenter
  • Randomized controlled trial
  • Septic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators (2017). High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: A multicenter randomized controlled trial. Critical Care, 21(1), [289]. https://doi.org/10.1186/s13054-017-1878-8

High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury : A multicenter randomized controlled trial. / for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators.

In: Critical Care, Vol. 21, No. 1, 289, 25.11.2017.

Research output: Contribution to journalArticle

for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators 2017, 'High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: A multicenter randomized controlled trial', Critical Care, vol. 21, no. 1, 289. https://doi.org/10.1186/s13054-017-1878-8
for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators. High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: A multicenter randomized controlled trial. Critical Care. 2017 Nov 25;21(1). 289. https://doi.org/10.1186/s13054-017-1878-8
for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators. / High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury : A multicenter randomized controlled trial. In: Critical Care. 2017 ; Vol. 21, No. 1.
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TY - JOUR

T1 - High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury

T2 - A multicenter randomized controlled trial

AU - for the Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators

AU - Chung, Kevin K.

AU - Coates, Elsa C.

AU - Smith, David J.

AU - Karlnoski, Rachel A.

AU - Hickerson, William L.

AU - Arnold-Ross, Angela L.

AU - Mosier, Michael J.

AU - Halerz, Marcia

AU - Sprague, Amy M.

AU - Mullins, Robert F.

AU - Caruso, Daniel M.

AU - Albrecht, Marlene

AU - Arnoldo, Brett D.

AU - Burris, Agnes M.

AU - Taylor, Sandra L.

AU - Wolf, Steven

AU - Pamplin, Erica A.

AU - Rauschendorfer, Cathy A.

AU - Charo-Griego, Sonya

AU - Hatem, Victoria D.

AU - Tercero, Javance R.

AU - Welker, Linda S.

AU - Tran, Thanh

AU - Bolling, Kristina R.

AU - Conrad, Peggie F.

AU - Parker, Farrah J.

AU - Richey, Karen J.

AU - Schein, Renee R.

AU - Murphy, Wendy L.

AU - Haney, Starre A.

AU - Renteria, Jessica

AU - Jones, Victoria

AU - Tran, Christopher

AU - Ross, Doug

AU - McDonald, Tracy

AU - Parks, Jennifer

AU - King, Booker T.

AU - Rizzo, Julie A.

AU - Pamplin, Jeremy C.

AU - Driscoll, Ian R.

AU - Renz, Evan M.

AU - Lundy, Jonathan B.

AU - Cancio, Leopoldo C.

AU - Cruse, Carl W.

AU - McFarren, Christopher A.

AU - Brown, Kimberly S.

AU - Showkat, Arif

AU - George, Lekha

AU - Kumar, Aneel

AU - Birmingham, Barbara

PY - 2017/11/25

Y1 - 2017/11/25

N2 - Background: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. Methods: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices. Results: During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups. Conclusions: HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined. Trial registration: Clinicaltrials.gov NCT01213914. Registered 30 September 2010.

AB - Background: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. Methods: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices. Results: During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups. Conclusions: HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined. Trial registration: Clinicaltrials.gov NCT01213914. Registered 30 September 2010.

KW - Acute kidney injury

KW - Burns

KW - High-volume hemofiltration

KW - Multicenter

KW - Randomized controlled trial

KW - Septic shock

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