Effectiveness of short-term 6-hour high-volume hemofiltration during refractory severe septic shock

Abstract

III, therapeutic study.

Ammonia clearance with haemofiltration in adults with liver disease

“…In most critically ill patients, CRRT is primarily used at low volumes and reported to be optimally delivered at a dose of 25 ml/kg/h . High‐volume CRRT at 60–90 ml/kg/h is more expensive, but may have additional beneficial metabolic and inflammatory consequences, reported to include improvements in haemodynamic stability and reductions in vasopressor requirement, possibly through modulation of pro‐inflammatory mediators . It may also act as an adjunctive technique for controlling body temperature, an integral component to the management of intracranial hypertension in traumatic brain injury and ALF .…”

Type-5 Cardiorenal Syndrome (CRS-5): An up to Date

“…Fluid therapy must be carefully managed to avoid fluid overload and other iatrogenic complications (88). Since inflammation and immune disorders play an important role in the pathogenesis of sepsis, the removal of cytokines and immunomodulation are 2 approaches based on extracorporeal techniques utilizing convection, high-volume hemofiltration, and high-permeability membranes (89). The best results were obtained with high-permeability membranes and absorption (89).…”

“…There is no role for dopamine for improving renal hemodynamics (94) and there are limited studies with fenoldopam (95). Norepinephrine decreases renal perfusion in normal conditions, but increases systemic blood pressure in septic patients (89), while vasopressin increases diuresis and the GFR in septic patients (96).…”

Sepsis: An Example of Type 5 Cardiorenal Syndrome

“…La terapia deve mirare al trattamento della patologia di base e a quello delle complicanze cardio-renali. Dal momento in cui lo stato infi ammatorio e il coinvolgimento del sistema immunitario giocano un ruolo patogenetico di primo piano nello sviluppo della sepsi, la rimozione delle citochine coinvolte e la terapia immunomodulante rappresentano due approcci fondamentali; essi sono basati sull'impiego di tecniche di depurazione extracorporee che utilizzano metodiche convettive, elevati volumi di emofi ltrazione e membrane di dialisi ad alta permeabilità (40)(41)(42). Un'alternativa, non sempre facilmente applicabile, è costituita dalla possibilità di colpire selettivamente gli elementi cellulari implicati nella genesi di processi apoptotici e nell'attivazione leucocitaria per poi rimuoverli con dializzatori costituiti da polimixina (43,44) o con apparecchi citoferetici selettivi che utilizzano l'anticoagulazione con citrato (45).…”