The International journal of artificial organs
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Plasma therapies are being applied to thombotic syndromes, but there are limited controlled studies. ⋯ As we understand more about the pathophysiology of thrombotic syndromes, specific plasma therapies can be applied for the specific need of a particular patient population. There are sufficient preliminary data to recommend a definitive RCT to evaluate the efficacy of the different types of plasma therapies in secondary thrombotic syndromes.
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Extracorporeal blood purification treatment (EBT) methods have been used in the treatment of experimental and human SIRS/Sepsis in a variety of settings and with variable reports of efficacy and safety. Their role in the management of SIRS/Sepsis remains controversial. ⋯ Broad consensus can be achieved on several aspects of EBT and can be used to inform clinical practice and to help guide the establishment of a future research agenda.
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The application of artificial organs to the task of blood purification in the setting of non-renal organ failure simultaneously presents important challenges and opportunities. Failures of cardiovascular, hepatic, coagulation and immune systems are all characterized by dysregulation leading to multi-organ failure. When sustained, these conditions result in multiple organ system dysfunction and death and are far too common in modern intensive care units (ICUs). ⋯ Furthermore, given the many failed trials of specific therapy, the recent focus of immunomodulatory therapy in sepsis has shifted to non-specific methods of influencing the entire inflammatory response without suppressing it. In this issue of the journal, members of the Acute Dialysis Quality Initiative (ADQI) present systematic reviews on the application of hemofiltration, ultrafiltration, plasma therapies and liver-assist therapy for the treatment of non-renal organ failure. The focus of these reviews is on clinical evidence as well as recommendations for future research.
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Sequential dialysis techniques (i.e pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of inadequate efficiency and lack of technology lead to the decline of such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to on-line fluid preparation systems. ⋯ The treatments resulted safe, easy, feasible and well tolerated with an improved hemodynamic response to high volume convective therapies. Adequacy of treatment was satisfactory in all SCT schedules while middle molecular weight solute clearance and removal resulted higher in treatments with higher convective component. SCT might represent an interesting option for the future especially in patients with hemodynamic instability and requirements for interventions during treatment.