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Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design

Circulating inflammatory mediators spilling into the circulation from sites of active inflammation are considered the source of remote tissue injury and associated organ dysfunction in sepsis. Hemofiltration has been proposed as a therapy for sepsis based on its ability to remove circulating inflamm...

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Detalles Bibliográficos
Autores principales: Honoré, Patrick M, Matson, James R
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2002
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137327/
https://www.ncbi.nlm.nih.gov/pubmed/12398774
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author Honoré, Patrick M
Matson, James R
author_facet Honoré, Patrick M
Matson, James R
author_sort Honoré, Patrick M
collection PubMed
description Circulating inflammatory mediators spilling into the circulation from sites of active inflammation are considered the source of remote tissue injury and associated organ dysfunction in sepsis. Hemofiltration has been proposed as a therapy for sepsis based on its ability to remove circulating inflammatory mediators by sieving or by adsorption, or both. Designing devices and methods for sepsis therapy will require optimization of these two mechanisms. In the present issue of Critical Care Forum, Kellum and Dishart report the relative effects of sieving and adsorption on plasma IL-6 following cecal ligation and puncture in rats. The authors conclude that hemoadsorption is the main mechanism of removal, and discuss some possible implications for filter design but hemoadsorption is well dependant on hemofiltration (the so-called hemofiltration filter adsorption/synergistic effect). It is important to recognize the limitations of conventional systems; Kellum and Dishart have extended our knowledge of hemofiltration filter adsorption, which is quite different from conventional hemoadsorption. If sepsis is a manifestation of a nonlinear dynamic control system out of control, then filtration at modest doses with a large pore filter may succeed as well as high-volume hemofiltration with a conventional cut-off filter. In the present paper, we will explore the strengths and the weaknesses of the 'Kellum and Dishart' study and discussing their findings in the light of the current available literature.
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spelling pubmed-1373272003-02-27 Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design Honoré, Patrick M Matson, James R Crit Care Commentary Circulating inflammatory mediators spilling into the circulation from sites of active inflammation are considered the source of remote tissue injury and associated organ dysfunction in sepsis. Hemofiltration has been proposed as a therapy for sepsis based on its ability to remove circulating inflammatory mediators by sieving or by adsorption, or both. Designing devices and methods for sepsis therapy will require optimization of these two mechanisms. In the present issue of Critical Care Forum, Kellum and Dishart report the relative effects of sieving and adsorption on plasma IL-6 following cecal ligation and puncture in rats. The authors conclude that hemoadsorption is the main mechanism of removal, and discuss some possible implications for filter design but hemoadsorption is well dependant on hemofiltration (the so-called hemofiltration filter adsorption/synergistic effect). It is important to recognize the limitations of conventional systems; Kellum and Dishart have extended our knowledge of hemofiltration filter adsorption, which is quite different from conventional hemoadsorption. If sepsis is a manifestation of a nonlinear dynamic control system out of control, then filtration at modest doses with a large pore filter may succeed as well as high-volume hemofiltration with a conventional cut-off filter. In the present paper, we will explore the strengths and the weaknesses of the 'Kellum and Dishart' study and discussing their findings in the light of the current available literature. BioMed Central 2002 2002-09-04 /pmc/articles/PMC137327/ /pubmed/12398774 Text en Copyright © 2002 BioMed Central Ltd
spellingShingle Commentary
Honoré, Patrick M
Matson, James R
Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title_full Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title_fullStr Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title_full_unstemmed Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title_short Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
title_sort hemofiltration, adsorption, sieving and the challenge of sepsis therapy design
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137327/
https://www.ncbi.nlm.nih.gov/pubmed/12398774
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