Evaluation of Hemodynamic Effects of Cascade Hemofiltration in Septic Shock (Cascade)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00922870
Recruitment Status : Completed
First Posted : June 17, 2009
Last Update Posted : April 5, 2017
Gambro Lundia AB
Information provided by (Responsible Party):
Baxter Healthcare Corporation

Brief Summary:

Septic shock is a major cause of mortality and morbidity in critically ill patients. Septic Shock is associated with an overwhelming, systemic overflow of pro inflammatory and anti-inflammatory mediators, which leads to generalized endothelial damage, multiple organ failure, and altered cellular immunological responsiveness. Although our understanding of the complex pathophysiological alterations that occur in septic shock has increased greatly as a result of recent clinical and preclinical studies, mortality associated with the disorder remains unacceptably high, ranging from 30% to 50%. To date, attempts to improve survival with innovative, predominantly anti-inflammatory therapeutic strategies have been disappointing. A standard hemofiltration rate of 35 ml/kg/hour has been successfully used to treat acute renal failure. However, this dose does not alter plasma levels of inflammatory mediators, suggesting that its ability to clear these mediators is suboptimal. Higher doses of hemofiltration (up to 120 ml/kg per hour) have been demonstrated to improve cardiac function and hemodynamics in several animal models of sepsis. High-volume hemofiltration (HVHF) was thus conceived and applied in patients with septic shock, showing an improvements in hemodynamics with decreased vasopressor requirements and improved survival in patients admitted after a cardiac arrest.

The main benefit described with high volume hemofiltration is a hemodynamic improvement (e.g reduction in catecholamines' requirement). This improvement seems to be due to the removal of a badly defined network of middle molecular weight peptides. To remove efficiently these middle molecular peptides, a high filtration rate is needed. However, with high filtration rates, there is also a high clearance for smaller molecules, including antibiotics, electrolytes, vitamins, trace elements and amino acids.

The cascade hemofiltration system has been designed for a more efficient removal of middle molecular weight peptides with a limited solute consumption.

The goal of this study is the evaluation of the hemodynamic improvement using cascade hemofiltration in patients treated for septic shock.

Condition or disease Intervention/treatment Phase
Sepsis Device: Cascade Other: Standard treatment Not Applicable

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Evaluation of Hemodynamic Effects of Cascade Hemofiltration in Septic Shock
Study Start Date : April 2009
Actual Primary Completion Date : March 2013
Actual Study Completion Date : March 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Sepsis Shock
U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: Standard treatment Other: Standard treatment
Standard therapy
Experimental: Cascade Device: Cascade
Cascade treatment over 48h

Primary Outcome Measures :
  1. the primary outcome will be the number of days without catecholamines at the 28th day of randomization [ Time Frame: 28th day ]

Secondary Outcome Measures :
  1. rate of decrease of catecholamines during the first 72h, days without mechanical ventilation at D90, days without RRT for acute renal failure at D90, days without ICU requirement at D90, status at D90. [ Time Frame: 72h, D90 ]

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient with a septic shock diagnosed by the medical staff team.
  • Patient mechanically ventilated and treated by high doses of catecholamines after adequate fluid administration (≥ 1.0 mg/h of norepinephrine or epinephrine) for ≥ 120 minutes and < 24h.

Exclusion Criteria:

  • Age (years) < 18 or > 85.
  • Weight >120 kg
  • Thrombocytopenia 50< G/l or Neutrophils <0.5 Giga/l
  • Contra indication to heparin anticoagulation.
  • Patient requiring catecholamines (epinephrine ≥ 1 mg/h or norepinephrine ≥ 1 mg/h) for >24h.
  • Patient admitted to the ICU ≥ 7 days before the inclusion criteria.
  • Comorbid conditions with an expected survival < 6 months
  • Inclusion (<28 days) in another study interfering with the goals of the current investigation.
  • Pregnancy
  • Immune compromised patients (e.g. being treated for cancer, treated by immunosuppressors or steroids, AIDS).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00922870

CHU hospital
Clermont-Ferrand, France, 63003
Hopital Le Bocage
Dijon, France, 21079
Centre Hospitalier Marc JACQUET
Melun, France, 77 000
Hopital Tenon
Paris, France, 75020
Hopital Delafontaine
Saint Denis, France, 93205
Sponsors and Collaborators
Baxter Healthcare Corporation
Gambro Lundia AB
Study Chair: Monchi Mehran, Dr Unaffiliate

Responsible Party: Baxter Healthcare Corporation Identifier: NCT00922870     History of Changes
Other Study ID Numbers: 1450
First Posted: June 17, 2009    Key Record Dates
Last Update Posted: April 5, 2017
Last Verified: April 2017

Additional relevant MeSH terms:
Shock, Septic
Systemic Inflammatory Response Syndrome
Pathologic Processes