Open AccessContinuous Hemofiltration in 2009: What Is New for Clinicians Regarding Pathophysiology, Preferred Technique and Recommended Dose?
Author(s) -
Patrick M. Honoré,
Olivier Joannès-Boyau,
Vincent Collin,
W. Boer,
Serge Jennes
Publication year - 2009
Publication title -
blood purification
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 57
eISSN - 1421-9735
pISSN - 0253-5068
DOI - 10.1159/000227282
Subject(s) - hemofiltration , medicine , limiting , ultrafiltration (renal) , intensive care medicine , clinical practice , randomized controlled trial , surgery , hemodialysis , physical therapy , mechanical engineering , chemistry , chromatography , engineering
In the last years, publications have questioned the classical dose of 35 ml/kg, but are those studies strong enough in terms of scientific power in order to change our practice? We will try to settle some recommendations for clinicians. Manipulation of dose, porosity, and combinations have yielded promising findings. However, conclusive evidence based on randomized trials remains scarce, limiting the practical implementation in daily practice. From the few designed studies, it is safe to say that optimization of delivered dose has a proven positive effect. An ultrafiltration rate of around 35 ml/kg/h, with adjustment for predilution, can be recommended for the septic patient. Recent studies do not have enough power to change this recommendation in view of its shortcomings. Finally the recommendation is to keep going with a continuous technique, a pure continuous veno-venous hemofiltration mode, and at a dose of 35 ml/kg/h while waiting for other studies to be published.