In-line filtration minimizes organ dysfunction: New aspects from a prospective, randomized, controlled trial

In this single-centre, prospective, randomized controlled trial 807 critically ill children were assigned to either control (n？=？406) or filter group (n？=？401), the latter receiving in-line filtration for complete infusion therapy. Both groups were compared regarding the differences of incidence rates and its 95% confidence interval (CI) of different organ dysfunction as defined by the International Pediatric Sepsis Consensus Conference 2005.The incidence rates of respiratory (？5.06%; 95% CI, ？9.52 to ？0.59%), renal (？3.87%; 95% CI, ？7.58 to ？0.15%) and hematologic (？3.89%; 95% CI, ？7.26 to ？0.51%) dysfunction were decreased in the filter group. No difference was demonstrated for the occurrence rates of cardiovascular, hepatic, or neurologic dysfunction between both groups.In-line filtration has beneficial effects on the preservation of hematologic, renal and respiratory function in critically ill patients. The presented clinical data further support our hypothesis regarding potential harmful effects of particles. In critically ill patients infused particles may lead to further deterioration of the microcirculation, induce a systemic hypercoagulability and inflammation with consecutive negative effects on organ function.ClinicalTrials.gov number; NCT00209768Infusion of particles is a side effect of intravenous therapy [1-3]. Particulate contamination is inherent to the applied drug formulation. It arises from drug incompatibility reactions, incomplete reconstitution of drugs, or components of the infusion systems [4]. On an intensive care unit, up to one million particles may be infused per day [3] depending on the complexity and quantity of the infused solutions [5]. Different mechanisms of particle damage to various organs have been proven either by experimental or clinical studies. These include mechanical blockage of small–diameter arterioles and capillaries [6], activation of platelets, neutrophiles and/or endothelial cells [1] with a subsequent generation of o