(精选)【持续性肾脏替代治疗CRRT英文精品课件】Continuous Renal Replacement Therapy(51p)教学课件.pptVIP

CLP model of acute peritonitis in pig 24 hrs of CAVH vs no CAVH ex vivo test of PMN phagocytosis for Candida (T0, T24, 48, 72H) hemodynamic, gazometric biologic data CAVH ATTENUATES PMN PHAGOCYTOSIS IN PORCINE MODEL OF PRITONITIS A. DiScipio et al, Am J Surg. 173; 1997 CAVH ATTENUATES PMN PHAGOCYTOSIS IN PORCINE MODEL OF PERITONITIS (A. DiScipio et al, Am J Surg. 173; 1997) RESULTS No difference in hemodynamic gasometric parameters between CAVH control CAVH decreases intensity of PMN phagocytosis (opsonisation) and PMN hyperactivity until the early phase of sepsis Extensive activation of inflammatory responses mediators vasoactive cardiodepressant organ dysfunction Supportive Therapies Symptomatic Symptomatic + Mediator Regulation (HF) - Removal of inflammatory mediators - Fluid balance control - Metabolic status control CHANGE IN MORTALITY ? PEEP ventilation Hemodialysis persistant SIRS MODS CONVECTIVE ELIMINATION OF CYTOKINES The concept of “the tip of the iceberg” (JM Cavaillon) : Plasma elevation of cytokines == saturation of : Origin cells Target cells Extracellular compartment Plasma removal may have then small effect in term of tissue/cell levels of cytokines CONVECTIVE ELIMINATION OF CYTOKINES No drop in serum levels of IL except IL-1 More rapid production than elimination Shift of IL from the tissues to the serum High volume hemofiltration ? Coupled HVHF + HADsorption ? Elimination of inflammatory mediators by hemofiltration mediator elimination change study ref. Bacterial toxins : Endotoxin Adsorption ? Ex-vivo, An. Vanholder, Matéo Lipid A Adsorption ? Ex-vivo Dinarello Anaphylatoxins : C3a Filtration ? Human Hoffmann C5a Adsorption ? Human Hoffmann Arachidonic acid derivatives : TxB2 Filtration ? Animal Heidemann 6-keto PGF2 Filtration ? An. Hum