Reiter Karl, Bellomo Rinaldo, Ronco Claudio, Kellum John A
University Children's Hospital, Muenchen, Germany.
Crit Care. 2002 Feb;6(1):18-21. doi: 10.1186/cc1448. Epub 2002 Jan 11.
Although there have been exciting advances in the management of sepsis and septic shock, mortality still remains high. Recent data suggest that high-volume hemofiltration (HVHF) may play a role in these patients. In contrast to the usual rate of hemofiltration, HVHF is felt to be better able to remove the inflammatory mediators associated with sepsis and septic shock. Such an approach is currently incapable of selectively removing specific mediators. This may be a problem when one considers that several mediators may in fact be beneficial. When determining whether HVHF should be instituted in a patient with septic shock, one need remember that its role is far from clear and its usefulness remains the subject of much debate. Although early data is encouraging, it is clear that additional data is required before HVHF becomes standard management. The authors of this pro/con debate, which is based on a clinical scenario, first describe their own position and then respond to their opponent's position.
尽管在脓毒症和脓毒性休克的治疗方面已经取得了令人振奋的进展，但死亡率仍然很高。最近的数据表明，高容量血液滤过（HVHF）可能对这些患者有作用。与通常的血液滤过速率相比，HVHF被认为更能够清除与脓毒症和脓毒性休克相关的炎症介质。目前这种方法无法选择性地清除特定介质。当考虑到几种介质实际上可能是有益的时，这可能会成为一个问题。在确定是否应对脓毒性休克患者实施HVHF时，需要记住其作用远未明确，其效用仍然是许多争论的主题。尽管早期数据令人鼓舞，但很明显在HVHF成为标准治疗方法之前还需要更多数据。这场基于临床病例的正反方辩论的作者们，首先阐述了他们自己的立场，然后回应了对方的立场。
