Hemofiltration for Respiratory Failure After Bone Marrow Transplantation
| Status: | Completed |
|---|---|
| Conditions: | Cardiology, Pulmonary, Hematology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Hematology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any - 21 |
| Updated: | 4/2/2016 |
| Start Date: | January 2005 |
| End Date: | September 2008 |
| Contact: | Joseph V DiCarlo, MD |
| Email: | jdicarlo@stanford.edu |
| Phone: | (650) 497-8850 |
Hemofiltration for Respiratory Failure Following Hematopoietic Stem Cell Transplantation
For children undergoing bone marrow transplantation, respiratory failure is a devastating
complication, with mortality expectations well above 60%. The researchers have devised a
novel strategy that may greatly improve survival. Hemofiltration, a continuous form of
dialysis, was designed as a therapy for critically ill patients with kidney failure. A
semi-permeable membrane removes plasma water and solutes (up to about 35,000 Daltons
molecular weight). The researchers have treated immuno-compromised children with respiratory
failure with hemofiltration. Many inflammatory molecules are of a size well below the limit
of the filter. Hemofiltration might remove a critical amount of this inflammatory material,
attenuating the unregulated inflammatory response that is central to the development of
respiratory failure and progression to multiple organ failure and death. The researchers are
conducting a multi-center trial of early continuous hemofiltration for respiratory failure
in children following bone marrow transplantation. The researchers will analyze blood and
ultrafiltrate using sensitive proteomic methods to detect several inflammatory biochemicals
known to be active in this disease, looking for evidence that early active hemofiltration
alters the inflammatory response. The researchers will test whether `early` hemofiltration
produces greater survival from respiratory failure in this vulnerable population.
complication, with mortality expectations well above 60%. The researchers have devised a
novel strategy that may greatly improve survival. Hemofiltration, a continuous form of
dialysis, was designed as a therapy for critically ill patients with kidney failure. A
semi-permeable membrane removes plasma water and solutes (up to about 35,000 Daltons
molecular weight). The researchers have treated immuno-compromised children with respiratory
failure with hemofiltration. Many inflammatory molecules are of a size well below the limit
of the filter. Hemofiltration might remove a critical amount of this inflammatory material,
attenuating the unregulated inflammatory response that is central to the development of
respiratory failure and progression to multiple organ failure and death. The researchers are
conducting a multi-center trial of early continuous hemofiltration for respiratory failure
in children following bone marrow transplantation. The researchers will analyze blood and
ultrafiltrate using sensitive proteomic methods to detect several inflammatory biochemicals
known to be active in this disease, looking for evidence that early active hemofiltration
alters the inflammatory response. The researchers will test whether `early` hemofiltration
produces greater survival from respiratory failure in this vulnerable population.
For children undergoing bone marrow transplantation, respiratory failure carries mortality
expectations well above 60%. The researchers have published preliminary evidence that
continuous hemofiltration may greatly improve survival, if filtration is begun when the
child first fulfills clinical criteria for ARDS. This is a departure from standard practice,
as hemofiltration is usually begun later in the course (if at all) when multiple organ
failure is entrenched. Hemofiltration, a `renal replacement therapy` for critically ill
patients, is a slow, continuous process in which a semi-permeable membrane removes plasma
water and solutes (up to about 35 kiloDaltons). Many cytokine and chemokine molecules are
smaller than the molecular weight limit of the filter; hemofiltration might remove a
critical amount, attenuating the unregulated inflammatory response responsible for
respiratory failure and progression to multiple organ failure and death. The researchers
will conduct a multi-center randomized trial assessing the effect of hemofiltration on
survival from respiratory after bone marrow (or more precisely, hematopoietic stem cell)
transplantation. The researchers will perform sensitive proteomic assays of serum and
ultrafiltrate, to detect the presence of cytokines and chemokines known to be active in
idiopathic pneumonia syndrome. Resulting profiles will constitute a uniquely complex
description of ultrafiltrate and may provide evidence for modulation of immune function by
hemofiltration.
expectations well above 60%. The researchers have published preliminary evidence that
continuous hemofiltration may greatly improve survival, if filtration is begun when the
child first fulfills clinical criteria for ARDS. This is a departure from standard practice,
as hemofiltration is usually begun later in the course (if at all) when multiple organ
failure is entrenched. Hemofiltration, a `renal replacement therapy` for critically ill
patients, is a slow, continuous process in which a semi-permeable membrane removes plasma
water and solutes (up to about 35 kiloDaltons). Many cytokine and chemokine molecules are
smaller than the molecular weight limit of the filter; hemofiltration might remove a
critical amount, attenuating the unregulated inflammatory response responsible for
respiratory failure and progression to multiple organ failure and death. The researchers
will conduct a multi-center randomized trial assessing the effect of hemofiltration on
survival from respiratory after bone marrow (or more precisely, hematopoietic stem cell)
transplantation. The researchers will perform sensitive proteomic assays of serum and
ultrafiltrate, to detect the presence of cytokines and chemokines known to be active in
idiopathic pneumonia syndrome. Resulting profiles will constitute a uniquely complex
description of ultrafiltrate and may provide evidence for modulation of immune function by
hemofiltration.
Inclusion Criteria:
- hematopoietic stem cell recipient
- respiratory failure fulfilling ARDS criteria
- mechanical ventilation (invasive / non-invasive)
Exclusion Criteria:
- extracorporeal membrane oxygenation (ECMO)
- predominance of congestive heart failure
- code status: a patient must be willing to accept invasive mechanical ventilation if
clinically indicated
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