In this episode, I’ll discuss whether adult critically ill patients benefit from inline filters.
Several studies (1,2,3&4) in pediatric patients have suggested that reducing particles in IV infusions results in positive patient outcomes. Although not all studies have found a benefit, those that have signal a reduction in ICU length of stay, thrombosis, sepsis, and organ failure.
Whether this potential benefit applies to adult patients is less well known.
A recent retrospective cohort study looking at this issue was published in the journal Critical Care.
Over 3000 critically ill adult patients were propensity score match and split into a fine filter group (using a 0.2 or 1.2-micron inline filter) or a normal filter group (using a 5-micron filter).
The 2 groups were compared for the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay.
The fine filter group had a statistically significant improvement in respiratory dysfunction, pneumonia, interleukin-6 levels, and hospital and ICU length of stay. Only the rates of severe vasoplegia and acute kidney injury were no different between groups.
The authors concluded:
In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients.
Both the fine and normal filter sizes remove glass, rubber, and plastic particles from IV infusions. Only the fine filters of 0.2 or 1.2 microns remove particles from drug incompatibilities, air, microorganisms (normal bacteria size 1–3 μm), and smaller endotoxins. This additional filtration appeared to have a clinically meaningful benefit in this study.
While one single-center retrospective study is not enough to issue sweeping guidelines to use fine filters in adult critically ill patients, this study was large and well designed. Based on the IL-6 reduction in the fine filter group, the data suggest that particles in IV solutions increase the systemic inflammation response, and filtering those particles can decrease the adverse effect of that inflammation
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