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In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial.

Jack T, Boehne M, Brent BE, Hoy L, Köditz H, Wessel A, Sasse M - Intensive Care Med (2012)

Bottom Line: Analysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group.Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97-4.82] vs. 2.98 [2.33-3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6-22.4] vs. 11.0 [7.1-14.9] h; P = 0.028) were significantly reduced.The overall complication rate during the PICU stay among the filter group was significantly reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.

ABSTRACT

Purpose: Particulate contamination due to infusion therapy carries a potential health risk for intensive care patients.

Methods: This single-centre, prospective, randomized controlled trial assessed the effects of filtration of intravenous fluids on the reduction of complications in critically ill children admitted to a pediatric intensive care unit (PICU). A total of 807 subjects were randomly assigned to either a control (n = 406) or filter group (n = 401), with the latter receiving in-line filtration. The primary endpoint was reduction in the rate of overall complications, which included the occurrence of systemic inflammatory response syndrome (SIRS), sepsis, organ failure (circulation, lung, liver, kidney) and thrombosis. Secondary objectives were a reduction in the length of stay on the PICU and overall hospital stay. Duration of mechanical ventilation and mortality were also analyzed.

Findings: Analysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group. In particular, the incidence of SIRS was significantly lower (n = 123 [30.3 %] vs. n = 90 [22.4 %]; P = 0.01). Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97-4.82] vs. 2.98 [2.33-3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6-22.4] vs. 11.0 [7.1-14.9] h; P = 0.028) were significantly reduced.

Conclusion: In-line filtration is able to avert severe complications in critically ill patients. The overall complication rate during the PICU stay among the filter group was significantly reduced. In-line filtration was effective in reducing the occurrence of SIRS. We therefore conclude that in-line filtration improves the safety of intensive care therapy and represents a preventive strategy that results in a significant reduction of the length of stay in the PICU and duration of mechanical ventilation (ClinicalTrials.gov number: NCT00209768).

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Enrolment of study subjects. Single asterisk denotes exclusion criteria: recruitment for other studies, 18 years of age or older, no infusion therapy during the stay in the pediatric intensive care unit (PICU). Double asterisk denotes other reasons for exclusion: no informed consent due to foreign language and ethical reasons. In four patients allocated to the filter group the intervention was discontinued. One patient in the control group and 8 patients in the filter group were excluded due to incorrect allocation. Fourteen patients (8 control, 6 filter group) were excluded during the final validation because of incomplete data in the medical charts
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Fig1: Enrolment of study subjects. Single asterisk denotes exclusion criteria: recruitment for other studies, 18 years of age or older, no infusion therapy during the stay in the pediatric intensive care unit (PICU). Double asterisk denotes other reasons for exclusion: no informed consent due to foreign language and ethical reasons. In four patients allocated to the filter group the intervention was discontinued. One patient in the control group and 8 patients in the filter group were excluded due to incorrect allocation. Fourteen patients (8 control, 6 filter group) were excluded during the final validation because of incomplete data in the medical charts

Mentions: All patients younger than 18 years of age who were admitted to the PICU during the study period were eligible for enrollment (n = 2,542). Subjects expected to die within 48 h of admission, such as those under cardiopulmonary resuscitation, and patients already recruited for other trials or without any intravenous therapy were excluded (Fig. 1). Written informed consent was obtained for each child from their legal guardians on admission. A total of 1,147 patients met the inclusion criteria. These patients were randomly allocated to either the control or filter group based on a computer-generated simple unrestricted randomization list. Discharge within 6 h after admission was defined as an exclusion criterion. Fourteen patients (8 control, 6 filter group) were excluded during final validation due to missing relevant clinical data in their charts. The final analysis included 807 patients (343 female, 464 male) (Fig. 1).Fig. 1


In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial.

Jack T, Boehne M, Brent BE, Hoy L, Köditz H, Wessel A, Sasse M - Intensive Care Med (2012)

Enrolment of study subjects. Single asterisk denotes exclusion criteria: recruitment for other studies, 18 years of age or older, no infusion therapy during the stay in the pediatric intensive care unit (PICU). Double asterisk denotes other reasons for exclusion: no informed consent due to foreign language and ethical reasons. In four patients allocated to the filter group the intervention was discontinued. One patient in the control group and 8 patients in the filter group were excluded due to incorrect allocation. Fourteen patients (8 control, 6 filter group) were excluded during the final validation because of incomplete data in the medical charts
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351606&req=5

Fig1: Enrolment of study subjects. Single asterisk denotes exclusion criteria: recruitment for other studies, 18 years of age or older, no infusion therapy during the stay in the pediatric intensive care unit (PICU). Double asterisk denotes other reasons for exclusion: no informed consent due to foreign language and ethical reasons. In four patients allocated to the filter group the intervention was discontinued. One patient in the control group and 8 patients in the filter group were excluded due to incorrect allocation. Fourteen patients (8 control, 6 filter group) were excluded during the final validation because of incomplete data in the medical charts
Mentions: All patients younger than 18 years of age who were admitted to the PICU during the study period were eligible for enrollment (n = 2,542). Subjects expected to die within 48 h of admission, such as those under cardiopulmonary resuscitation, and patients already recruited for other trials or without any intravenous therapy were excluded (Fig. 1). Written informed consent was obtained for each child from their legal guardians on admission. A total of 1,147 patients met the inclusion criteria. These patients were randomly allocated to either the control or filter group based on a computer-generated simple unrestricted randomization list. Discharge within 6 h after admission was defined as an exclusion criterion. Fourteen patients (8 control, 6 filter group) were excluded during final validation due to missing relevant clinical data in their charts. The final analysis included 807 patients (343 female, 464 male) (Fig. 1).Fig. 1

Bottom Line: Analysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group.Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97-4.82] vs. 2.98 [2.33-3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6-22.4] vs. 11.0 [7.1-14.9] h; P = 0.028) were significantly reduced.The overall complication rate during the PICU stay among the filter group was significantly reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.

ABSTRACT

Purpose: Particulate contamination due to infusion therapy carries a potential health risk for intensive care patients.

Methods: This single-centre, prospective, randomized controlled trial assessed the effects of filtration of intravenous fluids on the reduction of complications in critically ill children admitted to a pediatric intensive care unit (PICU). A total of 807 subjects were randomly assigned to either a control (n = 406) or filter group (n = 401), with the latter receiving in-line filtration. The primary endpoint was reduction in the rate of overall complications, which included the occurrence of systemic inflammatory response syndrome (SIRS), sepsis, organ failure (circulation, lung, liver, kidney) and thrombosis. Secondary objectives were a reduction in the length of stay on the PICU and overall hospital stay. Duration of mechanical ventilation and mortality were also analyzed.

Findings: Analysis demonstrated a significant reduction in the overall complication rate (n = 166 [40.9 %] vs. n = 124 [30.9 %]; P = 0.003) for the filter group. In particular, the incidence of SIRS was significantly lower (n = 123 [30.3 %] vs. n = 90 [22.4 %]; P = 0.01). Moreover the length of stay on PICU (3.89 [95 % confidence interval 2.97-4.82] vs. 2.98 [2.33-3.64]; P = 0.025) and duration of mechanical ventilation (14.0 [5.6-22.4] vs. 11.0 [7.1-14.9] h; P = 0.028) were significantly reduced.

Conclusion: In-line filtration is able to avert severe complications in critically ill patients. The overall complication rate during the PICU stay among the filter group was significantly reduced. In-line filtration was effective in reducing the occurrence of SIRS. We therefore conclude that in-line filtration improves the safety of intensive care therapy and represents a preventive strategy that results in a significant reduction of the length of stay in the PICU and duration of mechanical ventilation (ClinicalTrials.gov number: NCT00209768).

Show MeSH
Related in: MedlinePlus