UittrekselSepsis and SIRS are characterized by a massive
and uncontrolled release of inflammatory
mediators into the circulation. The inflammatory
turmoil causes biological alterations,
hemodynamic instability, and tissue damage.
Continuous renal replacement therapy (CRRT)
may offer an interesting way to restore disturbed
homeostasis by significantly reducing the
inflammatory load.The most intensely debated
item regarding continuous hemofiltration was the
filtration dose needed to obtain the best outcome
at the least untoward effects. Therefore, we
prepared the path for a large randomized trial
[the IVOIRE (hIgh VOlume in Intensive caRE)
trial] that compared standard dose (35 ml/kg/h)
with high dose (70 ml/kg/h) continuous
hemofiltration as adjunctive treatment of septic
shock complicated by acute kidney injury (AKI).
Ultimately, the IVOIRE trial showed that mortality
at 90 days was not different between both dose
groups but appeared to be much lower as
compared to similar studies that included less
severely ill patients. This unexpectedly low
mortality (approximately 50 %) may be
explained by a more early start of hemofiltration
at a lower level of kidney damage (i.e. "Injury"
instead of "Failure", according to the
standardized RIFLE classification for AKI). In
summary, the results of the IVOIRE trial strongly
argue against using a hemofiltration dose
exceeding 35 ml/kg/h for adjunctive treatment of
septic shock with AKI but suggest that
hemofiltration is best and safely initiated at RIFLE
"Injury" stage.To date, CRRT remains the only
valid and performing technique for hemodynamic
unstable, in particular septic, patients with AKI.
Future studies should focus on the use of new
filtration membranes and sorbents.
|Datum Prijs||11 jun 2012|
|Begeleider||Luc Huyghens (Promotor), Herbert Spapen (Promotor), Christian Tielemans (Jury), Ives Hubloue (Jury), Guy Van Camp (Jury), Lui G Forni (Jury), Eric Hoste (Jury) & Pierre Damas (Jury)|