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Intensive Care Medicine pp 365–372Cite as

Hemofiltration and Hybrid Therapies in 2010

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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.

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Author information

Authors and Affiliations

  1. ICU High and Medium Care Burn Center, Queen Astrid Military Hospital, Rue Bruyn 1, 1120, Brussels, Belgium

    P. M. Honoré & T. Rose

  2. Department of Intensive Care, Haut Leveque University Hospital of Bordeaux, Pessac, France

    O. Joannes-Boyau

Authors
  1. P. M. Honoré
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  2. O. Joannes-Boyau
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  3. T. Rose
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

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Honoré, P.M., Joannes-Boyau, O., Rose, T. (2010). Hemofiltration and Hybrid Therapies in 2010. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5562-3_34

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  • DOI: https://doi.org/10.1007/978-1-4419-5562-3_34

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5561-6

  • Online ISBN: 978-1-4419-5562-3

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