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Minerva Anestesiologica 1999 June;65(6):419-26

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Present and future options in continuous renal replacement therapies of sepsis and MOF

Tetta C. ², Ronco C. ³, Brendolan A. ³, Irone M. ¹, Digito A. ¹, Cioffi M. ¹, Piccinni P. ¹, Dan M. ¹, Inguaggiato P. ², La Greca G. ³

¹ Department Clinical and Laboratory Research, Bellco SpA - Mirandola (Modena); ² Department of Nephrology, S. Bortolo Hospital - Vicenza; ³ Intensive Care Units, S. Bortolo Hospital - Vicenza

Conventional con­tin­u­ous extra­cor­po­real treat­ments ­such as hemo­fil­tra­tion and hemo­di­a­fil­tra­tion ­have not ­achieved sig­nif­i­cant reduc­tion in cyto­kine plas­ma lev­els, in ­spite of ­their increas­ing pop­u­lar­ity main­ly relat­ed to the unnec­es­sary ­fluid restric­tion there­by ren­der­ing ade­quate calor­ic ­intake pos­sible (Actualités Nephrologiques, 1994). This is main­ly due to ­reduced fil­tra­tion, to satur­abil­ity of the adsorp­tion-relat­ed phe­nom­e­na and to the ­absence of a con­vec­tive ­mass trans­fer. New approach­es ­have ­been ­more recent­ly intro­duced. The con­cept of ­blood pur­ifi­ca­tion has ­been ­amplied in ­some new inno­va­tive tech­niques ­that use non-selec­tive or selec­tive sor­bents. We ­will ­focus on the cri­te­ria ­used by oth­ers and us to ­assess the effi­cien­cy in ­vitro and in ani­mal mod­els of sep­sis of ­more recent­ly intro­duced non-selec­tive and selec­tive devic­es. Among the inno­va­tive tech­niques, modal­ities ­aimed at the plas­ma treat­ment ­will ­receive empha­sis. These modal­ities ­that are ­based on plas­ma fil­tra­tion ­with the use of dif­fer­ent sor­bents. The pre­lim­i­nary ­results ­obtained ­from ongo­ing clin­i­cal ­trials ­will be pre­sent­ed. We ­will ­also ­expand on the tech­ni­cal, bio­log­i­cal and clin­i­cal ­aspects ­that ­should be ­addressed in ­order to estab­lish a new modal­ity as inno­va­tive in the treat­ment of sep­sis.