Blood Purification by Hemofiltration in Septic Shock and Multiple Organ Dysfunction Syndrome Patients
In 1984 and 1986 Gotloib et al. [1, 2] published their positive experiences with intermittent hemofiltration in muhiple organ dysfunction syndrome (MODS) patients. The concept of blood purification by hemofiltration was received with a lot of scepticism, but nonetheless stimulated several research groups to analyze retrospective data and to perform prospective studies on this topic. Besides these chnical studies, a smah number of animal experimental studies have been performed. Undoubtedly, the high expectations with which the studies on the administration of monoclonal antibodies were welcomed as the therapy of the future diminished interest in the less prestigious hemofihration studies in MODS patients and animal models. It now seems reasonable to say that the use of monoclonals is promising and fascinating, but at the same time expensive and as yet of unproven value. The same holds for hemofiltration in this context; nonetheless, several centers have experience with this technique and use it routinely in therapy-resistant septic and cardiogenic shock. This chapter will describe the rationale for hemofiltration in shock and present an overview of the chnical and experimental studies performed so far; moreover, the limitations of the studies so far and ideas about future research wih be discussed.
KeywordsPermeability Catheter Ischemia Prostaglandin Stein
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- 6.Fiddian-Green RG (1989) Studies in splanchnic ischemia and muhiple organ failure. In: Marston A, Bulkley GB, Fiddian-Green RG et al. (eds) Splanchnic ischemia and multiple organ failure. Arnold, London, pp 349–363Google Scholar
- 8.Knauss WA, Wagner DP (1989) MSOF: epidemiology and prognosis. Crit Care Clin 5:221–226Google Scholar
- 10.Hoffman WD, Natanson C (1993) The role of endotoxin in bacterial septic shock. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine 1993. Springer, Berhn Heidelberg New York, pp 49–63Google Scholar
- 13.Geronemus R, Schneider N (1984) Continuous arteriovenous haemodialysis: a new treatment modality for acute renal failure. ASAIO Trans 30:610–613Google Scholar
- 15.Weiss L, Danielson BG, Wikstrom B et al. (1987) Condnuous arteriovenous hemofiltration in the treatment of 100 critically ill patients with acute renal failure: report on clinically outcome and nutritional aspects. Clin Nephrol 31:184–189Google Scholar
- 25.Klehr HU, Kaschell HJ, Kuckenbecker CH et al. (1985) Chnical results of continuous arteriovenous hemofiltration. In: Sieberth HG, Mann H (eds) Continuous arteriovenous hemofiltration. Karger, Basel, pp 159–165Google Scholar
- 31.Bellomo R, Tipping P, Boyce N (1991) Tumor necrosis factor clearances during continuous veno-venous hemodiafihration. ASAIO Trans 37:322–323Google Scholar
- 32.Staubach KH, Rau HG, Hohlbach G et al. (1987) Continuous arteriovenous hemofiltration in shock: a new strategy to lower eicosanoids. Artif Organs 11:A336Google Scholar
- 37.Grootendorst AF, van Bommel EFH, van Leengoed LAMG et al. (1994) High volume hemofiltration improves hemodynamics and survival of pigs exposed to gut ischemia and reperfusion. Shock 1:1–8Google Scholar
- 41.Grootendorst AF, van Bommel EFH, van Leengoed LAMG et al. (1994) High volume hemofiltration improves hemodynamics and survival of pigs exposed to bowel ischemia and reperfusion. Shock 1(5): 1–8Google Scholar