Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 18

Different techniques are available today for the therapy of the critically ill patient with renal and other organ dysfunction. An interesting aspect is the definition of an “adequate” dose of dialysis in AKI and the potential of different therapies for the treatment of sepsis [9–15]. Originally, 35 mL/kg/h was the value identified to maximize survival, whereas higher doses did not seem to give additional benefits in the general population [9]. Subsequent studies have demonstrated that lower doses can be equally safe and successful in treating the critically ill patient, although effective delivery often differs significantly from prescription [11–20]. The second concept introduces the rationale for high-volume hemofiltration in specific patients with acute renal failure and sepsis [21–27]. High-volume hemofiltration or coupled plasma filtration adsorption can be seen as a potent powerful immunomodulatory treatment in sepsis. Since sepsis and systemic inflammatory response syndrome are characterized by a cytokine network that is synergistic, redundant, autocatalytic, and self-augmenting, the control of such a nonlinear system cannot be approached by simple blockade or elimination of some specific mediators. Therefore, nonspecific removal of a broad range of inflammatory mediators by high-volume hemofiltration and coupled plasma filtration adsorption may be beneficial as recently suggested on the basis of the “peak concentration” hypothesis [24–27].