Hemofiltration in sepsis and systemic inflammatory response syndrome: The role of dosing and timing

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous. Albeit indirectly, our findings also argue in support of the notion that haemofiltration appears to be the most effective when applied as pre-treatment or concomitantly with the septic or endotoxemic insult [21,51,52], which might limit the clinical applicability.…”

“…Although limited in their robustness and methodological aspects, several human [9][10][11][12][13][14][15] and animal [16][17][18][19][20] studies further support the concept of high-volume haemofiltration (HVHF) in the treatment of endotoxemia or septic shock, mainly by demonstrating a reduced need for vasopressors dose and better hemodynamic stability. However, human studies were either uncontrolled or retrospective, thereby limiting the inference that could be drawn [21]. Similarly, the clinical relevance of some experimental studies focusing predominantly on haemodynamics, gas exchange, plasma cytokine levels, immunoparalysis and short-term survival, is limited by the fact that (1) haemofiltration was started before, during or very early after the septic or endotoxemic insult [21]; (2) the treatment effects were investigated mostly in hypodynamic models characterized by hypotension and low cardiac output, which is in contrast to the hyperdynamic pattern commonly seen in patients with septic shock.…”

“…However, human studies were either uncontrolled or retrospective, thereby limiting the inference that could be drawn [21]. Similarly, the clinical relevance of some experimental studies focusing predominantly on haemodynamics, gas exchange, plasma cytokine levels, immunoparalysis and short-term survival, is limited by the fact that (1) haemofiltration was started before, during or very early after the septic or endotoxemic insult [21]; (2) the treatment effects were investigated mostly in hypodynamic models characterized by hypotension and low cardiac output, which is in contrast to the hyperdynamic pattern commonly seen in patients with septic shock. Finally, all studies compared the effects of HVHF either with untreated subjects or with low volume haemofiltration (i.e.…”

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

“…Theoretically, high-dose CRRT could remove mediators by convection and/or adsorption (44,61) and reduce mortality, even in the absence of ARF (62). However, most current clinical practice guidelines suggest that the traditional doses of CRRT used in ARF, with or without sepsis, are insufficient to remove these mediators and recommend using at least 35 ml/kg/hour of ultrafiltration (10,63).…”

“…The effect of hemofiltration is more pronounced for those mediators who are in a higher plasma concentration (10).…”