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Hemofiltration and Hybrid Therapies in 2010

  • P. M. Honoré
  • O. Joannes-Boyau
  • T. Rose
Conference paper

Abstract

Despite major recent therapeutic improvements, septic shock remains a leading cause of mortality in intensive care patients [1]. In addition, it is important to realize that the mortality rate of patients with septic acute kidney injury (AKI) is much higher than that of patients with non-septic AKI [2]. For more than a decade, it has been suggested that reducing blood cytokine levels in such patients could, at least theoretically, lead to reduced mortality [3, 4]; however, in view of the complexity of the pharmacodynamics and pharmacokinetics of cytokines, this concept is not so simple to apply. Indeed, recent studies have attempted to demonstrate that high volume hemofiltration (HVHF) with enhanced adsorption can modulate and ameliorate sepsis-induced hemodynamic instability [5]. This recently published paper [5] suggested that membranes with enhanced adsorption are the key and that increased extraction from the central circulation is sufficient to obtain a beneficial clinical effect. It seems at least theoretically reasonable that effectively removing mediators from the tissue where they are harmful, and transporting them to the central circulation must be effective. Therefore, HVHF and enhanced adsorption should work synergistically in this model. In order to consolidate this hypothesis, it seems fruitful to discuss the three separate theories that have been put forward in recent years as possible explanations for the clinical findings observed in septic patients who underwent a number of different blood purification techniques. The HVHF and hybrid techniques that are currently available to the clinician are diverse and deserve a brief description.

Keywords

Septic Shock Renal Replacement Therapy Acute Kidney Injury Septic Patient Blood Compartment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media Inc. 2010

Authors and Affiliations

  • P. M. Honoré
    • 1
  • O. Joannes-Boyau
    • 2
  • T. Rose
    • 1
  1. 1.ICU High and Medium Care Burn CenterQueen Astrid Military HospitalBrusselsBelgium
  2. 2.Department of Intensive CareHaut Leveque University Hospital of BordeauxPessacFrance

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