Continuous haemofiltration in the intensive care unit

Continuous renal replacement therapy (CRRT) was first described in 1977 for the treatment of diuretic-unresponsive fluid overload in the intensive car e unit (ICU). Since that time this treatment has undergone a remarkable tec hnical and conceptual evolution. It is now available in most tertiary ICUs around the world and has almost completely replaced intermittent haemodialy sis (IHD) in some countries. Specially made machines are now available, and venovenous therapies that use blood pumps have replaced simpler techniques . Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superi or. The use of CRRT has also spurred renewed interest in the broader concep t of blood purification, particularly in septic states. Experimental eviden ce suggests that this is a promising approach to the management of septic s hock in critically ill patients. The evolution and use of CRRT is likely to continue and grow over the next decade.