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From Continuous Renal Replacement Therapies to Multiple Organ Support Therapy
Contributions to Nephrology
|March 30, 2018
Summary
Multiple organ dysfunction syndrome (MODS) is rising in ICUs, often linked to sepsis. Extracorporeal blood purification, like continuous renal replacement therapy (CRRT), shows promise for supporting multiple organs simultaneously, not just the kidneys.
Area of Science:
- Critical Care Medicine
- Nephrology
- Sepsis Pathophysiology
Background:
- Multiple organ dysfunction syndrome (MODS) incidence is increasing in intensive care units (ICUs), frequently associated with sepsis and leading to mortality.
- ICU patient demographics have shifted, including more severe cases and older individuals, increasing MODS risk.
- Historically, renal replacement therapy (RRT) was primary for acute renal failure, but technological advances now support other organ systems.
Purpose of the Study:
- To explore the potential of extracorporeal blood purification as a multi-organ support therapy.
- To investigate if treating blood extracorporeally can positively impact various organ systems beyond renal support.
- To re-evaluate the role of extracorporeal therapies in the context of sepsis and MODS.
Main Methods:
- Review of existing literature on Multiple Organ Dysfunction Syndrome (MODS) and sepsis management.
- Analysis of the principles and applications of extracorporeal therapies, particularly continuous renal replacement therapies (CRRT).
- Consideration of the commonality of blood contact across organs and extracorporeal treatments.
Main Results:
- Continuous renal replacement therapies (CRRT) offer hemodynamic stability and effective treatment for hypercatabolism and fluid overload in critically ill patients.
- Advanced CRRT techniques, such as high-volume hemofiltration, show promising results in septic patients.
- The shared characteristic of blood contact between organs and extracorporeal therapies suggests a unified approach.
Conclusions:
- Extracorporeal blood purification, by treating blood, has the potential to act as a multiple organ support therapy.
- A "humoral" theory of MODS, focusing on blood-borne mediators, supports the use of extracorporeal therapies for multi-systemic support.
- Future research should consider extracorporeal therapies as integrated solutions for MODS, not limited to single-organ support.
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