Artificial Organ Treatment for Multiple Organ Failure, Acute Renal Failure, and Sepsis: Recent New Trends

Abstract

Sepsis remains the major cause of mortality worldwide, claiming millions of lives each year. The past decade has seen major advances in the understanding of the biological mechanisms involved in this complex process. Unfortunately, no definitive therapy yet exists that can successfully treat sepsis and its complications. At variance with targeting single mediators, therapeutic intervention aimed at the nonselective removal of pro- and anti-inflammatory mediators seems a rational concept and a possible key to successful extracorporeal therapies. A further advantage may lie in the continuous nature of such therapy. With such continuous therapy, sequentially appearing peaks of systemic mediator overflow may be attenuated and persistently high plasma levels reduced. This theoretical framework is proposed as the underlying biological rationale for a series of innovative modalities in sepsis. In this editorial, we will review recent animal and human trials that lend support to this concept. We will also review the importance of treatment dose during continuous renal replacement therapy as a major factor affecting survival in critically ill patients with acute renal failure. Additionally, we will review novel information related to other blood purification techniques using large pore membranes or plasma filtration with adsorbent perfusion. Although these approaches are still in the early stages of clinical testing, they are conceptually promising and might represent an important advance.

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

“…Acute renal failure is often a late and devastating complication of MODS with a mortality rate exceeding 70% 13 . Isolated ARF is uncommon but has a frequency of 20–50% in severe sepsis 11 .…”

“…Since it is commonly associated with MODS, ARF is generally treated in the PICU. The targets of any RRT in critically ill patients should mimic the functions and physiology of the native organ, ensure qualitive and quantitative blood purification, restore and maintain homeostasis, avoid complications, and have good clinical tolerance providing the kind of homeostasis that favors organ recovery 1,13–16 . The most frequent cause of ARF is septic shock 14,16 .…”

“…Acute renal failure is often a late and devastating complication of MODS with a mortality rate exceeding 70%. 13 Isolated ARF is uncommon but has a frequency of 20 -50% in severe sepsis. 11 Plotz et al reported the development of ARF in seven of the 22 children with septic shock and mortality rate was found to be 57.1% in patients with ARF and 6.7% in patients without ARF.…”

Current status of dosing and quantification of acute renal replacement therapy. Part 2: Dosing paradigms and clinical implementation (Review Article)

“…are twofold. First, the study was underpowered with only a 20% power of detecting a 20% relative reduction in mortality with the ‘early high volume group’ 21 . The second, and in the author’s opinion more important reason, is that therapy requirements are likely to be different among postcardiosurgical patients.…”

“…First, the study was underpowered with only a 20% power of detecting a 20% relative reduction in mortality with the 'early high volume group'. 21 The second, and in the author's opinion more important reason, is that therapy requirements are likely to be different among postcardiosurgical patients. As with the Cleveland Clinic studies, there are probably subgroups within the patient population of this study from whom factors other than ARRT prescription and delivery are more important determinants of outcomes.…”