Blood purification in the intensive care unit: Evolving concepts

Until relatively recently surgeons were familiar with the concept that some of their patients admitted to the intensive care unit require dialysis to deal with the development of severe acute renal failure. Under such circums tances the nephrology team would then attend the patient and take over that aspect of management. More recently, however, this situation has undergone a significant evolution because of the advent of continuous renal replacem ent therapy (CRRT), First introduced as "last ditch" therapy in the most cr itically ill patients who were hemodynamically intolerant of hemodialysis, CRRT has become more and more widely used. It is now the dominant form of a rtificial renal support in Australia and close to being the dominant treatm ent of the severe acute renal failure of critical illness in most European countries. The use of CRRT in the United States is rapidly growing. The arr ival of CRRT has also renewed interest in the wider concept of blood purifi cation during critical illness. Experimental and preliminary human data sug gest that such blood purification therapies may indeed have beneficial immu nomodulatory effects. Accordingly, CRRT is now being considered as a potent ial adjuvant treatment of septic shock and has even moved into the operatin g room as a tool for antiinflammatory therapy and volume control. The inten sivist-surgeon and the general surgeon need to be aware of and understand t hese developments in extracorporeal therapy if they wish to make the full a rmamentarium of modern treatment available to their sickest patients.