High-Volume Hemofiltration in Sepsis and SIRS: Current Concepts and Future Prospects

Abstract

In recent years, a number of techniques have been studied and developed in the field of renal replacement therapy in the septic patient. Manipulation of ultrafiltrate dose, membrane porosity, mode of clearance, and combinations of techniques have yielded promising findings. However, at present, conclusive evidence based on well-designed, randomized controlled trials remains scarce, limiting the practical implementation of many techniques in daily practice outside the context of a study. From the few well-designed and documented studies that we have so far, it is safe to say that optimalization of delivered dose in renal replacement therapy has a proven positive effect. An ultrafiltration rate between 35 and 45 ml/kg/h, with adjustment for predilution and down time, can be recommended for the septic patient until other data are available. The results of further dose outcome studies with higher ultrafiltration rates will likely be the stepping stone to further improvements in daily clinical practice.

Effects of high-volume hemofiltration on alveolararterial oxygen exchange in patients with refractory septic shock

“…[15] HVHF refers to displacement liquid velocity>45 mL/ kg per hour or ultrafi ltration volume>60 L/d. [16] Compared with CVVHF, HVHF can clear not only solutes with small molecular weight (water, serum creatinine, urea World J Emerg Med, Vol 2, No 2, 2011 Ren et al nitrogen, and electrolysis), but also solutes with large molecular weight (inflammatory factors, and toxic substance), which may interrupt waterfall-like chain reaction of inflammatory factors, and alleviate organ injury. HVHF can increase P a O 2 and oxygenation index, decrease P a CO 2 , improve heart and lung function, remove toxin, and ameliorate blood electrolyte disturbances and acid-base imbalance.…”

Extracorporeal blood purification for sepsis

“…55 Nonetheless in clinical practice, 35 mL/kg/h is not that high and can be achieved with ease, especially in those with low body weight. To clarify this issue, Honore et al 56 defined continuous HVHF as 50 to 70 mL/kg/h, and 100 to 120 mL/kg/h for 4 to 8 hours followed by conventional CVVH as pulse HVHF. In addition, HVHF is regarded as effective blood purification therapy because circulating inflammatory mediators are mostly water-soluble and range between 5 kDa and 60 kDa.…”

Acute Renal Injury in polytrauma patients

“…[44][45][46] Honoré et al 47 introduziram o conceito da retirada de metabólitos e mediadores inflamatórios do plasma, com consequente retirada rápida destes moduladores do interstício, mantendo um equilíbrio com os mesmos valores plasmáticos de mediadores inflamatórios, mas com redução da concentração de mediadores intersticiais.…”