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In-Line Filtration Reduces SIRS in Critically Ill Children: Presented at ISICEM By Evelyn Harvey BRUSSELS, Belgium -- March 27, 2009 -- Using in-line filters during infusion reduces the incidence of severe inflammatory response syndrome (SIRS) in critically ill children, according to data presented here at the 29th International Symposium on Intensive Care and Emergency Medicine (ISICEM). Investigators led by Thomas Jack, Department of Paediatric Cardiology and Intensive Medicine, Hannover Medical School, Germany, conducted the randomised, prospective trial to determine the effects of in-line filtration on the incidence of major complications in critically ill children in the paediatrics intensive care unit (PICU). Results of the trial were presented here on March 27. "Particulate contamination of infusion solution implies a potential health risk for intensive care patients on a background of debilitation and impaired host responses," the researchers stated. "We assessed the effect of in-line filtration on the reduction of major complications in critically ill children." Dr. Jack and colleagues recruited and randomised 171 girls and 227 boys with a mean age of 72 months to receive nonfiltered (n = 208) or filtered (n = 190) infusions. The in-line infusion filter systems used were Pall ELD96LLCE/NOE96E, with Braun Intrapur Lipid/Intrapur Neonat Lipid. Children in the study were admitted to the PICU for a variety of diagnoses, but these were balanced between filter and nonfilter groups. Cardiac conditions were the most prevalent cause of illness. All patients had a standardised central venous catheter arrangement, which included parenteral nutrition, bolus injections, catecholamine and volume therapy, and monitoring of central venous pressure. Infusion regimens were optimised and standardised prior to the study to prevent precipitation or incompatibility reactions between drugs and solutions. In-line filtration showed a clear benefit, with a significant reduction in SIRS in the filtered group (P = .035). Particles contaminating the infusion solutions were seen on used filters using electron microscopy, according to the researchers. Typically, these were 40 x 60 mcM and angular in shape. Energy dispersive x-ray analysis showed they consisted mainly of silicon, suggesting that they came from glass ampoules, the investigators added. "The occurrence of sepsis, SIRS, thrombosis, or organ failure often complicates the course of disease in critically-ill patients. In-line filtration is most effective [for] reducing the incidence of SIRS," concluded the researchers. Additional analyses are expected to confirm the preliminary results and to further identify the influence of in-line filtration on other complications, they stated. The final results could have significant bearing on current clinical practice in PICUs. Funding for the trial was provided by Pall GmbH Medical and B. Braun Melsungen AG. [Presentation title: In-Line Filtration Reduces the Incidence of SIRS in Critically Ill Children. Abstract A680] E-mail this page to a friend or colleague! To print, use this version