Blood Purification Therapy to Prevent or Treat MOF
The concept of hemodialysis and peritoneal dialysis for renal failure, which has been so successful, has been expanded into a number of techniques caled blood purification. Plasmapheresis has a role in die management of refractory myasthenia gravis, Goodpasture syndrome, hemolytic uremia, and Guillain-Barré syndrome.1 There is no doubt that removal of toxic products from the blood, such as endotoxin and mediator cytokines, could help sick, injured and septic patients. A number of clinical trials have suggested benefit for patients with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF). There are a number of clinical problems that could be helped by such techniques in addition to the removal of potassium, urea nitrogen, and creatinine for renal failure (see Chapter 36). Potential benefits include (1) removal of excess fluid contributing to heart failure, pulmonary edema, and impaired arterial and tissue oxygenation; (2) removal of humoral mediators of inflammation; (3) removal of endotoxin; (4) nutritional management; (5) correction of fluid, electrolyte, and acid-base balance; (6) support as an artificial liver (see Chapter 44).
KeywordsCatheter Peroxide Filtration Convection Urea
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