tailieunhanh - Báo cáo y học: "Pro/con clinical debate: Is high-volume hemofiltration beneficial in the treatment of septic shock"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Pro/con clinical debate: Is high-volume hemofiltration beneficial in the treatment of septic shock? | Critical Care February 2002 Vol 6 No 1 Reiter et al. Commentary Pro con clinical debate Is high-volume hemofiltration beneficial in the treatment of septic shock Karl Reiter Rinaldo Bellomo Claudio Ronco and John A Kellum Professor of Pediatric Intensive Care University Children s Hospital Muenchen Germany Director of Intensive Care Research Austin Repatriation Medical Center Heidelberg Victoria Australia Professor of Nephrology S. Bortolo Hospital Vicenza Italy Associate Professor of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA Correspondence Critical Care Forum Editorial Office editorial@ Published online 11 January 2002 Critical Care 2002 6 18-21 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Although there have been exciting advances in the management of sepsis and septic shock mortality still remains high. Recent data suggest that high-volume hemofiltration HVHF may play a role in these patients. In contrast to the usual rate of hemofiltration HVHF is felt to be better able to remove the inflammatory mediators associated with sepsis and septic shock. Such an approach is currently incapable of selectively removing specific mediators. This may be a problem when one considers that several mediators may in fact be beneficial. When determining whether HVHF should be instituted in a patient with septic shock one need remember that its role is far from clear and its usefulness remains the subject of much debate. Although early data is encouraging it is clear that additional data is required before HVHF becomes standard management. The authors of this pro con debate which is based on a clinical scenario first describe their own position and then respond to their opponent s position. Keywords hemofiltration sepsis septic shock The scenario You have a 40-year-old male in your intensive care unit who has septic shock as a result of bacterial pneumonia. He is on moderate dose levophed to