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).
KeywordsSystemic Inflammatory Response Syndrome Multiple Organ Failure Continuous Renal Replacement Therapy Multiple Organ Dysfunction Syndrome Blood Purification
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- 4.Hanasawa K, Kodama M, Aoki H, et al: New treatment of severe sepsis in septic multiple organ failure patients by extracorporeal endotoxin removal with a polmyxin B immobilized fiber column. Surg Forum 1993; 44: 88–89.Google Scholar
- 6.Kodama M, Tani T, Maekawa K, et al: Endotoxin eliminating therapy in patients with severe sepsis-direct hemoperfusion using polymyxin B-immobilized fiber column. Jpn J Surg 1995; 96: 277–285.Google Scholar
- 11.Hrasawa H, Sugai T, Oda S, et al: Continuous hemodiafiltration can remove humoral mediators from bloodstream of the patients with systemic inflammatory response syndrome and multiple organ failure. Blood Purif 1997; 15: 136–137.Google Scholar
- 12.Hffman JN, Deppisch R, Faist E, et al: Hemofiltration in human sepsis: evidence of elimination of immunomodulatory substances. Surg Forum 1994; 45: 69–71.Google Scholar
- 13.Bllomo R, Baldwin I, Cole L, Ronco C: Preliminary experience with high-volume hemofiltration in human septic shock. Kidney Int 1998; 54-I (Suppl 66): S182–S185.Google Scholar
- 16.Oa S, Hirasawa H, Isono K: Tissue oxygen metabolism and cellular injury in patients with septic multiple organ failure. J Jpn Surg Soc 1993; 94: 556–563.Google Scholar
- 18.Hirasawa H, Sugai T, Ohtake Y, et al: Energy metabolism and nutritional support in anuric multiple organ failure patients. In: Tanaka T, Okada A (eds) Anuric Multiple Organ Failure Patients. Amsterdam, Elsevier, 1990; 429–440.Google Scholar