Hemofiltration in septic ards. the artificial kidney as, an artificial endocrine lung

Hemofiltration in Multiorgan Failure Syndrome Secondary to Sepsis: A Critical Analysis of Heterogeneity

“…(At the present time we are using a more biocom patible low-flux polysulfone.) In this setting, sieving coef ficients for most mediators ranged between 0.89 and 0.94. and were not significantly different from that estimated for urea [40], Even C5a, consistently present in plasma of patients with adult respiratory distress syndrome [41], showing a molecular weight of 11,200, is well within the Gauss curve centered at 10,000 D and. consequently, can also be ultrafiltered with the same membrane.…”

“…According to our observations, we concluded that with hemofiltra tion, the artificial kidney cleared the blood from most mediators of inflammation derived from the septic cas cade, as well as from those liberated by the interaction between circulating blood and the artificial membrane [42,43], acting as an endocrine artificial lung. In turn, hemodialysis solved the problem of the marked cardiodepressive effects of lactic acidosis [44] as well as the meta bolic alterations derived from renal failure [40]. Mean while, the clearing of interstitial edema during hemofiltra tion [45] would imply a significant step towards a return of the cellular environment to a situation of physiological homeostasis.…”

The Role of Hemofiltration in the Critically-III Intensive Care Unit Patient: Present and Future

“…Gotloib et al [12,13] described improved gas exchange and hemodynamics in ICU pa tients with ARDS treated by 1HF. These posi tive effects could not be explained by fluid removal as most patients had a positive over all fluid balance during treatment.…”

“…Recent, uncontrolled clinical studies sug gest that HF may improve hemodynamics, gas exchange and even survival in patients with septic shock, ARDS or MSOF [12,13,[45][46][47], These effects were attributed to the convective elimination of inflammatory me diators into the UF [12,13,46], This process may become an important issue, since it implies that renal replacement therapy not only should be chosen to remove urea and creatinine (which does not seem to affect mortality), but also to eliminate inflam matory mediators, involved in the develop ment of septic shock, ARDS and MSOF.…”

“…Another approach in this direction may be the application of hemofiltration (HF), as a means to remove inflammatory mediators [12,13], The beneficial potential of HF in the setting of MSOF is based on the fact that many known inflammatory mediators are middle or large molecular weight molecules (MW 500-20,000 daltons (Da) and might therefore be removed by this technique (in vitro molecular cut-off point HF membranes 40-50 kDa), thereby counteracting the overstimulation of host-defence mechanisms. This proposed beneficial effect is controver sial and somewhat contradicted by the obser vation that continuous HF, though able to control fluid balance and metabolic status of severely ill ARF patients, does not seem to reduce the high mortality of these patients [8,14].…”