• Didier Payen, Joaquim Mateo, Jean Marc Cavaillon, François Fraisse, Christian Floriot, Eric Vicaut, and Hemofiltration and Sepsis Group of the Collège National de Réanimation et de Médecine d'Urgence des Hôpitaux extra-Universitaires.
• Department of Anesthesiology and Critical Care Medicine, Lariboisière Hospital, University Paris, Paris, France. dpayen1234@aol.com
• Crit. Care Med. 2009 Mar 1;37(3):803-10.

ObjectiveThe impact of continuous venovenous hemofiltration on sepsis-induced multiple organ failure severity is controversial. We sought to assess the effect of early application of hemofiltration on the degree of organ dysfunction and plasma cytokine levels in patients with severe sepsis or septic shock.DesignProspective, randomized, open, multicenter study setting, 12 French intensive care units.PatientsA total of 80 patients were enrolled within 24 hours of development of the first organ failure related to a new septic insult.InterventionsPatients were randomized to group 1 (HF), who received hemofiltration (25 mL/kg/hr) for a 96-hour period, or group 2 (C) who were managed conventionally.Measurements And Main ResultsThe primary end point was the number, severity, and duration of organ failures during 14 days, as evaluated by the Sepsis-Related Organ Failure Assessment score, on an intention-to-treat analysis. Strict guidelines were provided to perform continuous hemofiltration under the same conditions and bearing the same objectives in all centers. Because of inclusion stagnation, the trial was discontinued after an interim analysis by which time 76 patients had been randomized. The number and severity of organ failures were significantly higher in the HF group (p < 0.05). No modifications in plasma cytokine levels could be detected.ConclusionThese data suggest that early application of standard continuous venovenous hemofiltration is deleterious in severe sepsis and septic shock. This study does not rule out an effect of high-volume hemofiltration (>35 mL/kg/hr) on the course of sepsis.

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