BLOOD FILTRATION IN CHILDREN WITH SEVERE SEPSIS - SAFE ADJUNCTIVE THERAPY

Objective: To review the safety and efficacy of haemofiltration and pl asmafiltration in children with severe sepsis. Design: Retrospective c ase notes analysis. Setting: University Paediatric Intensive Care Unit . Patients: All children admitted to the intensive care unit between N ovember 1985 and May 1992 with a primary diagnosis of severe sepsis wh o also received blood filtration therapy. Interventions: Continuous ha emofiltration (HF) 18 patients; continuous haemofiltration and plasmaf iltration (PF) 9 patients. Measurements and results: 27 children with sepsis-induced MOSF, median age 26.6 months (range 0.33-185), median w eight 12 kg (range 2.5-58), mean PRISM score 19.4 (SD 8.6), mean numbe r of organs failing 2.78 (SD 0.9) received filtration for a median dur ation of 36 hours (range 2-145). Eight (30%) survived (PIP 5/18, PF 3/ 9). There was no significant difference in the demographic features be tween the HF group and the PF group and no difference in mortality. Th e two groups were pooled to assess the effect of commencement of filtr ation on clinical wellbeing. Arterial blood gases, electrolytes, full blood examination, ventilator settings and doses of inotropes were rec orded immediately prior to commencement of filtration and 18 h after c ommencement. Serum anion gap and osmolality were calculated using conv entional formulae. There were no significant changes in the level of c ardiorespiratory support, or biochemical markers of severity following commencement of filtration. Platelet count fell 32% (p = 0.029) but n o bleeding was encountered. No severe complications were observed duri ng 1222 h of filtration. No bleeding or infection was observed at the site of cannulation. One child developed haemodynamic instability foll owing commencement of plasmafiltration necessitating abandonment of th e procedure. Conclusion: Haemofiltration or plasmafiltration can be pe rformed safely in children with severe sepsis but their effect on outc ome remains unknown.