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The highly selective semipermeable Oxiris membranes have shown to provide endotoxin adsorption and removal of different inflammatory cytokines which could improve hemodynamic stability in patients with septic shock and continuous kidney replacement therapy (CKRT) requirement. The aim of this study was to compare the clinical efficacy of CKRT using an Oxiris membrane to maintain the mean arterial pressure (MAP) >65mmHg, after 72 hours of treatment, with a lower vasopressor dose than the use of a conventional AN69 standard membrane.
Multicenter randomized controlled trial in critically ill patients with documented infection, on invasive mechanical ventilation, and the need of CKRT. Patients were randomized to receive continuous veno-venous hemodiafiltration using either an AN69 standard membrane or an AN69 Oxiris membrane. Regional citrate anticoagulation was used, all patients had a prescribed dose of 30mL/kg/h for 72 hours, and the filters were changed every 24h. Clinical variables were registered, and vasopressor dependency index was calculated to express the relationship between vasopressor dose and MAP.
Twenty-five patients have been included, 12 (48%) in the Oxiris group and 13 (52%) in the control group. The most common infection was pneumonia, 32% due to COVID-19, and the mean initial SOFA score was 11 points. There were no differences in MAP between the groups (Oxiris vs. Control) at 0, 24, 48 and 72 hours; 70 vs 70, 70 vs 79, 73 vs 77 and 79 vs 74 respectively. The rate of vasopressors was not different at baseline, 24, 48, and 72 hours, as shown in Figure 1. Fluid removal tended to be greater in the control group than in the Oxiris group with a median rate of 1,17 vs 0,53 (p = 0.05) at 24 h, 1,17 vs 1,15 at 48 h (p=0.57), and at 72 h with a rate of 1,21 vs 0,73 mL/kg/h (p=0.13). There were no differences in daily fluid balance.
Figure 1. Rate of vasopressors in both groups.
In this study there were no differences in the requirement of vasopressors to maintain hemodynamic stability in patients with septic shock and CKRT using the Oxiris membrane compared to the standard membrane.