Inline Filtration May Reduce SIRS Mortality in the Pediatric ICU

Deborah Brauser

January 14, 2010

January 14, 2010 (Miami Beach, Florida) — By using inline filtration, pediatric intensive care units (ICUs) can reduce the incidence of systemic inflammatory response syndrome (SIRS), according to a new randomized prospective study from Germany.

Dr. Thomas Jack

Interim results were presented here at the Society of Critical Care Medicine 39th Critical Care Congress in a poster session by Thomas Jack, MD, from the Department of Pediatric Cardiology and Intensive Care Medicine at the Hannover Medical School in Germany.

"Particles from contamination of infusion solution have been shown to induce thrombogenesis, deterioration of microcirculation, and modulation of immunoresponse," said Dr. Jack during his presentation. "Since the use of inline filtration with microfilters has been known to almost completely prevent particulate infusion, we wanted to look at the effect of this filtration on reducing major complications in critically ill children, including sepsis, thrombosis, organ failure, and SIRS."

He noted that SIRS was a particular focus, since it is a known prognosticator of organ failure. "It often complicates the treatment in neonatal or pediatric cardiac intensive care."

A total of 807 children (463 male; mean age, 6 years) admitted to the interdisciplinary pediatric ICU of Dr. Jack's medical center were enrolled in this study and randomized to either the intervention group (n = 401), in which infusion filters were used throughout their complete infusion therapy, or the control group (n = 406), in which no filters were used.

The inline filters were analyzed after their regular use and particles on the surface were counted and characterized by energy-dispersive X-ray analysis.

Results

Preliminary results showed a significant reduction in the incidence of SIRS in the intervention group, compared with the control group (200 vs 145 patients, respectively; P < .001).

Although there was a strong trend toward a reduction in acute lung failure in the intervention group, compared with the control group (35 vs 22 patients), it was not statistically significant.

"We also had a high trend in reducing mortality in the [intervention] group, compared with the control group," reported Dr. Jack.

There were no significant differences found between the 2 groups in the occurrence of circulatory, acute renal, or liver failure, or in sepsis or thrombosis. "These findings showed that inline filtration is a novel therapeutic option that is very effective in reducing the incidence of SIRS," said Dr. Jack.

He added: "I think we have [fewer] strategies to prevent SIRS in the [ICU]. We have strategies in the operating room and in the [floor] rooms. But in between, we have nothing. So this is a very easy way to do a bit of prevention with no side effects, and it does not harm the patients."

"I would recommend that clinicians think about their infusion regimen and be aware of particle contamination because these problems are [increasing]. If they [are searching] for an easy way to eliminate these factors, I would say to just use inline filters for their regimen."

An Interesting Study

"I thought this was an interesting study," said Robert Park, MD, professor of pediatrics at the State University of New York in Stony Brook. He was not involved with this study.

"I think that filtration is something to keep in mind, especially when it comes to a patient-safety issue," said Dr. Park.

"There has been a lot of talk about this, and some people advocate always using a needle with a filter in it, so you're not pulling in those little glass particles. I think these findings are too preliminary to draw global conclusions. However, if we find that a large number of patients are being affected by these contaminants, then having an inline filter would probably be the best thing to use. It certainly wouldn't hurt."

"However," Dr. Park acknowledged, "in this day and age of cost containment, saying that it couldn't hurt is probably not a viable argument for using this."

Dr. Jack and Dr. Park have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 39th Critical Care Congress: Abstract 887. Presented January 12, 2010.

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