Pa. Lee et al., CONTINUOUS ARTERIOVENOUS HEMOFILTRATION THERAPY FOR STAPHYLOCOCCUS-AUREUS-INDUCED SEPTICEMIA IN IMMATURE SWINE, Critical care medicine, 21(6), 1993, pp. 914-924
Objectives. The goals of this study were: a) to evaluate the efficacy
of controlled, continuous arteriovenous hemofiltration in improving mo
rbidity and mortality rates in an immature swine model of Staphylococc
us aureus-induced septicemia; b) to determine if ultrafiltrate from se
ptic animals contained mediators that produce pathophysiologic changes
observed in untreated S. aureus septic pigs. Design: Prospective, ran
domized, controlled study with age-matched controls. Setting. U.S. Dep
artment of Agriculture-licensed biomedical research facility.Subjects:
Sixty-five weaned Poland-China swine (4 to 6 wks of age; 5 to 10 kg).
Interventions. Part 1: Animals received a lethal dose of live S. aure
us (8 x 10(9) colony-forming units/kg) over 1 hr. The three treatment
groups included: hemofiltration group 1 (eight filtered, eight nonfilt
ered animals), plasma filtration fraction = 5.5%; hemofiltration group
2 (six filtered, six nonfiltered animals), filtration fraction = 16.6
%; and hemofiltration group 3 (six filtered, six nonfiltered animals),
filtration fraction = 33.4%. A control, nonseptic group of animals (n
= 4) was filtered to obtain 'clean' ultrafiltrate (hemofiltration gro
up 4). Part 2: Sterile ultrafiltrate concentrate batches obtained from
each group of filtered, septic animals were concentrated and infused
into healthy, nonseptic pigs (reinfusion groups 1 through 3). Measurem
ents and Main Results. Physiologic, biochemical, and hematologic varia
bles were measured in all animals every 1 to 3 hrs. Overall length of
survival was also recorded. In hemofiltration groups 1 through 3, filt
ered animals survived significantly longer than matched, nonfiltered (
sham-filtered) animals. Increments in survival time increased directly
with filtration fraction. Ultrafiltrate concentrate from septic pigs
produced death (LD41) and disease similar to those rates observed in u
ntreated S. aureus-septic pigs. Infusion of clean ultrafiltrate concen
trate produced no response. Conclusions: Continuous arteriovenous hemo
filtration significantly improved survival rates in swine with S. aure
us-induced sepsis. Resultant ultrafiltrate concentrate contained media
tors responsible for some pathophysiologic responses observed in this
animal model.