HEMOFILTRATION FOR SEPSIS AND MULTIPLE OR GAN FAILURE

Continuous renal replacement therapy (CRRT) has been used in intensive care units particularly in patients with sepsis or multiorgan failure . In comparison to intermittent haemodialysis, hemofiltration techniqu es offers an improved hemodynamic tolerance, related to the absence of osmotic pressure gradient. Indeed, hemofiltration is based on the phy sical principle of convection to remove substances from the plasma. Th e removal of substances that are released during sepsis, acute respira tory distress syndrome or multiorgan failure may be of particular inte rest. Several human studies have demonstrated that hemofiltration remo ves various inflammatory mediators, but the clinical significance of t his removal remains questionnable. If this removal occurs predominantl y by convection, interrest in hemofiltration will focus on high volume hemofiltration in order to obtain maximal ultrafiltrate flows. Patien ts with sepsis or multiorgan failure require close monitoring of most vital fonctions. The use of a CRRT technique emphasizes the importance of this monitoring and adds new monitoring issues relative to fluid b alance, anticoagulation, hypothermia or drug removal.