Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:25 September 2012
Reviewer: Jakob Izbicki
Reviewer's report:
The article evaluation the Hepa Wash tretment in pigs with acute liver failure
fullfills the conditions of a pilot study. 14 animals were part of the investigation 6
controll, 6 pigs with Hepa Wash Treatment and 2 with MARS Treatment. The fist
12 pigs were randomized to each group. One pig of the control group had to be
excluded from the study because of insufficient implementation of acute liver
failure. All animals in the Hepa Wash treatment group survived the 13 h
observation period, except for one that died after stopping treatment. Four of the
control animals died within this period. Hepa Wash was able to reduce significant
impairment of cerebral perfusion pressure, mean arterial pressure, enhanced
cardiac index, renal functiob, eliminated water soluble and protein bound toxins.
No Adverse events (intracranial blleding) were observed. The 2 pigs treated with
MARS developed after 12 hours of observation a dramatic increase of
intracranial pressure.
This is an intersteting arcticle comparing the different liver support systems Hepa
Wash and MARS. As mentioned already by the authors it is only a small sample
size. But the result are encouraging. The most important question is if this new
liver failure support system could offer a benefit for patients.
Mayor compulsary revisions:
1. The results are amazing and in contrast to already published papers, e.g the
increasing dramatic intracranile pressure is in contrast to results of Mitzner SR et
al Extracorporal support of the failing liver Curr Opin Crit Care 8 : 171-177 (2002)
and Mitzner et al Improvement of hepatorenal syndrome Liver Transpl 6:
277-286. Do the authors have an explanation for their results?
2. Could the authors explain why the Hepa wash method is superior to MARS or
Prometheus? The combination of detoxification capacity of water soluble and
protein-bound toxins and therefore is it possible that drugs eg antibiotics are also
elimated with this system?
3. The amelioration of organ systems as described in the article is caused by the
filter system or is the HEPA wash method also capable of suppurting the liver
(horman, synthetic) function?
4. Increasing intracranial pressure can have diifernt reasons, e.g. noise were all
animal experiments performed in the same way?
5.No Scoring Systems has been used. The duration of the experiment was too
short for using these Scoring Systems?
6. Are there any further results billirubin elemination, acid base elimanation,
temperature development?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:25 September 2012
Reviewer: Jakob Izbicki
Reviewer's report:
The article evaluation the Hepa Wash tretment in pigs with acute liver failure
fullfills the conditions of a pilot study. 14 animals were part of the investigation 6
controll, 6 pigs with Hepa Wash Treatment and 2 with MARS Treatment. The fist
12 pigs were randomized to each group. One pig of the control group had to be
excluded from the study because of insufficient implementation of acute liver
failure. All animals in the Hepa Wash treatment group survived the 13 h
observation period, except for one that died after stopping treatment. Four of the
control animals died within this period. Hepa Wash was able to reduce significant
impairment of cerebral perfusion pressure, mean arterial pressure, enhanced
cardiac index, renal functiob, eliminated water soluble and protein bound toxins.
No Adverse events (intracranial blleding) were observed. The 2 pigs treated with
MARS developed after 12 hours of observation a dramatic increase of
intracranial pressure.
This is an intersteting arcticle comparing the different liver support systems Hepa
Wash and MARS. As mentioned already by the authors it is only a small sample
size. But the result are encouraging. The most important question is if this new
liver failure support system could offer a benefit for patients.
Mayor compulsary revisions:
1. The results are amazing and in contrast to already published papers, e.g the
increasing dramatic intracranile pressure is in contrast to results of Mitzner SR et
al Extracorporal support of the failing liver Curr Opin Crit Care 8 : 171-177 (2002)
and Mitzner et al Improvement of hepatorenal syndrome Liver Transpl 6:
277-286. Do the authors have an explanation for their results?
2. Could the authors explain why the Hepa wash method is superior to MARS or
Prometheus? The combination of detoxification capacity of water soluble and
protein-bound toxins and therefore is it possible that drugs eg antibiotics are also
elimated with this system?
3. The amelioration of organ systems as described in the article is caused by the
filter system or is the HEPA wash method also capable of suppurting the liver
(horman, synthetic) function?
4. Increasing intracranial pressure can have diifernt reasons, e.g. noise were all
animal experiments performed in the same way?
5.No Scoring Systems has been used. The duration of the experiment was too
short for using these Scoring Systems?
6. Are there any further results billirubin elemination, acid base elimanation,
temperature development?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:25 September 2012
Reviewer: Jakob Izbicki
Reviewer's report:
The article evaluation the Hepa Wash tretment in pigs with acute liver failure
fullfills the conditions of a pilot study. 14 animals were part of the investigation 6
controll, 6 pigs with Hepa Wash Treatment and 2 with MARS Treatment. The fist
12 pigs were randomized to each group. One pig of the control group had to be
excluded from the study because of insufficient implementation of acute liver
failure. All animals in the Hepa Wash treatment group survived the 13 h
observation period, except for one that died after stopping treatment. Four of the
control animals died within this period. Hepa Wash was able to reduce significant
impairment of cerebral perfusion pressure, mean arterial pressure, enhanced
cardiac index, renal functiob, eliminated water soluble and protein bound toxins.
No Adverse events (intracranial blleding) were observed. The 2 pigs treated with
MARS developed after 12 hours of observation a dramatic increase of
intracranial pressure.
This is an intersteting arcticle comparing the different liver support systems Hepa
Wash and MARS. As mentioned already by the authors it is only a small sample
size. But the result are encouraging. The most important question is if this new
liver failure support system could offer a benefit for patients.
Mayor compulsary revisions:
1. The results are amazing and in contrast to already published papers, e.g the
increasing dramatic intracranile pressure is in contrast to results of Mitzner SR et
al Extracorporal support of the failing liver Curr Opin Crit Care 8 : 171-177 (2002)
and Mitzner et al Improvement of hepatorenal syndrome Liver Transpl 6:
277-286. Do the authors have an explanation for their results?
2. Could the authors explain why the Hepa wash method is superior to MARS or
Prometheus? The combination of detoxification capacity of water soluble and
protein-bound toxins and therefore is it possible that drugs eg antibiotics are also
elimated with this system?
3. The amelioration of organ systems as described in the article is caused by the
filter system or is the HEPA wash method also capable of suppurting the liver
(horman, synthetic) function?
4. Increasing intracranial pressure can have diifernt reasons, e.g. noise were all
animal experiments performed in the same way?
5.No Scoring Systems has been used. The duration of the experiment was too
short for using these Scoring Systems?
6. Are there any further results billirubin elemination, acid base elimanation,
temperature development?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
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