Fluid withdrawal in over-hydrated patients resistant to diuretics was obtained by means of a capillary haemofilter, using the arterio-venous pressure gradient for blood perfusion at a rate of 100 ml/min. The ultrafiltration rate was 200-600 ml/h and could be maintained as long as 48 h without changing the haemofilter. This method, which needs no technical investment, is easy and simple to handle for the physician, bears only a very low risk for the patient, and ensures a negative fluid balance even at a mean blood pressure of only 60 mm Hg.
564BRITISH MEDICAL JOURNAL 6 DECEMBER 1975 biotics. Polk and Lopez-Mayer25 gave cephaloridine alone in the same way, and their practice was followed by Evans and Pollock.2' Campbell28 relied on large doses of penicillin alone, and Stokes et all 9 reported encouraging preliminary results from two doses of a combination of lincomycin with either gentamicin or tobramycin. This form of prophylaxis is logical, innocuous, since side effects are unlikely from so few doses, and evidently effective. And it has wide applications: the more specialised uses of antibiotics in surgery, notably the prevention of infection in burns, cannot be discussed here. Among other applications in surgery are the prevention of urinary tract infections, referred to above, and the local application of antibiotics in wounds. This is another relatively innocuous use which is to be recommended in so far as it is proved effective. This type of use and the systemic administration of only a few doses are much to be preferred
Automatic fluid balancing, as obtained with the hemofiltration machines from Sartorius (Göttingen, West Germany) and Dialysetechnik (Karlsruhe, West Germany), is accurate enough to replace bed scales, which have been necessary in conventional hemodialysis for patients who are confined to beds. Side effects such as hypotension, nausea and muscle cramps during treatment may be reduced with these new machines, compared to conventional methods, provided that the rate of effective fluid withdrawal does not exceed 0.5 L/hr. In particular, the constant weight loss associated with automatic hemofiltration seems to be well tolerated by the patients with fewer side effects.
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