In-line filtration decreases systemic inflammatory response syndrome, renal and hematologic dysfunction in pediatric cardiac intensive care patients

Background: Infused particles may aggravate inflammatory syndromes as they induce thrombogenesis, deteriorate microcirculation and alter immu-noresponse. In a previous interim analysis we have shown that particle retentive in-line filtration prevented the occurrence of systemic inflamma-tory response syndrome (SIRS) in pediatric cardiac intensive care patients. Now, we investigated the effect of in-line filtration on several organ functions in the final subpopulation with cardiac disease (Clinical Trials.gov ID NCT 00209768).

Methods: Children were randomized to either control or filter group obtaining in-line filtration throughout complete infusion therapy. Differences between incidence rates of several complications such as SIRS, sepsis, organ failure and dysfunction were compared between both groups.

Results: 305 children (n=150 control, n=155 filter group) with cardiac disease were included in the final analysis. Most of them (n= 239) were admitted after cardiac surgery. Incidence rates of SIRS (-10.84%; 95% confidence interval (CI), -21.12 to -0.56%), renal (-9.01%; 95% CI, -16.94 to -1.08%) and hematologic (-6.86%; 95% CI, -13.33 to -0.39%) dysfunction were significantly decreased in the filter group. No differences were demonstrated for the occurrence of sepsis, any organ failure, and other organ dysfunctions between both groups.

Conclusions: In cardiac intensive care patients infused particles seem to aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction. Particle retentive in-line filtration is most effective reducing the incidence of SIRS, renal and hematologic dysfunction. In-line filtration offers a novel preventive option to lower morbidity in cardiac intensive care.