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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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Kaplan–Meier analysis for complication-free interval (a) or SIRS-free interval (b). Control (blue filled circle) and filter (red open rhombus) group (maximum PICU stay 28 days). Circles and rhombi indicate censored patients
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Fig3: Kaplan–Meier analysis for complication-free interval (a) or SIRS-free interval (b). Control (blue filled circle) and filter (red open rhombus) group (maximum PICU stay 28 days). Circles and rhombi indicate censored patients

Mentions: In-line filtration significantly decreased the overall complication rate from 40.9 % (n = 166) in the control group to 30.9 % (n = 124) in the filter group (P = 0.003), (Table 2; Fig. 2). The Kaplan–Meier method and log-rank test were used to analyze the time to first occurrence of any complication per patient (Fig. 3), and a significant difference between the control and filter group was found using the log-rank test (P = 0.003). The median of event-free time for the control group (7.0 ± 0.2 days) differed from that for the filter group (10.0 ± 1.9 days). The incidence of SIRS was significantly reduced in the filter group compared to that in the control group (22.4 [n = 90] vs. 30.3 % [n = 123], respectively; P = 0.01). Adjustment to the baseline risk calculation (PIM II) was performed for overall complication rate and SIRS without any relevant impact on statistical significance (Table 2). The Kaplan–Meier analysis revealed a significant difference in SIRS-free interval for the proportions of patients of both groups (P = 0.011 by the log-rank test) (Fig. 3). Although there were reductions in the incidence of sepsis, ARDS, circulatory failure, thrombosis, acute liver and acute renal failure in the filter group, these differences did not reach statistical significance (Table 2; Fig. 2).Table 2


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)

Kaplan–Meier analysis for complication-free interval (a) or SIRS-free interval (b). Control (blue filled circle) and filter (red open rhombus) group (maximum PICU stay 28 days). Circles and rhombi indicate censored patients
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Kaplan–Meier analysis for complication-free interval (a) or SIRS-free interval (b). Control (blue filled circle) and filter (red open rhombus) group (maximum PICU stay 28 days). Circles and rhombi indicate censored patients
Mentions: In-line filtration significantly decreased the overall complication rate from 40.9 % (n = 166) in the control group to 30.9 % (n = 124) in the filter group (P = 0.003), (Table 2; Fig. 2). The Kaplan–Meier method and log-rank test were used to analyze the time to first occurrence of any complication per patient (Fig. 3), and a significant difference between the control and filter group was found using the log-rank test (P = 0.003). The median of event-free time for the control group (7.0 ± 0.2 days) differed from that for the filter group (10.0 ± 1.9 days). The incidence of SIRS was significantly reduced in the filter group compared to that in the control group (22.4 [n = 90] vs. 30.3 % [n = 123], respectively; P = 0.01). Adjustment to the baseline risk calculation (PIM II) was performed for overall complication rate and SIRS without any relevant impact on statistical significance (Table 2). The Kaplan–Meier analysis revealed a significant difference in SIRS-free interval for the proportions of patients of both groups (P = 0.011 by the log-rank test) (Fig. 3). Although there were reductions in the incidence of sepsis, ARDS, circulatory failure, thrombosis, acute liver and acute renal failure in the filter group, these differences did not reach statistical significance (Table 2; Fig. 2).Table 2

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