Blood purification
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Review Historical Article
The role of hemofiltration in the critically-ill intensive care unit patient: present and future.
The development of acute renal failure (ARF) in intensive care unit (ICU) patients carries a poor prognosis. Today, most cases are no longer an isolated organ dysfunction but are part of a multiple system organ failure syndrome. Recently developed renal replacement therapies allow adequate metabolic control, even in highly catabolic and hemodynamically unstable patients. ⋯ Although hemofiltration has been shown to improve hemodynamics of experimental septic shock, convincing evidence that hemofiltration improves outcome of ICU patients is lacking. Available data suggest that high ultrafiltrate volumes may be needed to achieve clinically important beneficial effects of hemofiltration in these patients. Prospective, randomized trials in homogeneous patient groups are needed to assess the role of hemofiltration in patients with septic shock or multiple system organ failure.
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Tumor necrosis factor is a cytokine made by macrophages, monocytes and T cells that has been formed to play an important role in shock, cachexia and inflammation. The importance of this cytokine eliciting shock and cachexia in mammals is reviewed.