Abstract
Multiple organ dysfunction syndrome is the leading cause of mortality in critically ill patients and is responsible for a large amount of healthcare expenditure. Since the probability of death is directly correlated to the number of failing organs beyond the kidney and the degree of physiological derangement, a clinically sensible approach is to broaden the spectrum of physiological endpoints targeted by extracorporeal therapy. Blood is the vital element that regulates all body systems from cellular to organ level. Continuous renal replacement therapy (CRRT) has direct access to blood and thus to all organ systems. The evolution of CRRT from simple renal replacement to a multiorgan support therapy (MOST) is logical and should be the goal of extracorporeal blood purification in the intensive care unit. This review explains why MOST represents the most logical future conceptual and practical evolution of CRRT and illustrates the biological rationale, supplying animal and clinical evidence that confirms the need to move in this direction theoretically, practically and technologically.
| Abbreviations | ||
| ALI | = | acute lung injury |
| ARF | = | acute renal failure |
| CARS | = | compensated anti-inflammatory response syndrome |
| CAST | = | continuous attenuation of sepsis therapy |
| CPFA | = | coupled plasma filtration adsorption |
| CRRT | = | continuous renal replacement therapy |
| CVVH | = | continuous venovenous haemofiltration |
| CVVHD | = | continuous venovenous haemodialysis |
| HVHF | = | high-volume haemofiltration |
| ICU | = | intensive care unit |
| IL-1 | = | interleukin-1 |
| IL-6 | = | interleukin-6 |
| IL-8 | = | interleukin-8 |
| LPS | = | lipopolysaccharide |
| MARS | = | molecular adsorbent recirculating system |
| MODS | = | multiple organ dysfunction syndrome |
| MOST | = | multiple organ support therapies |
| PAF | = | platelet-activating factor |
| RRT | = | renal replacement therapy |
| SIRS | = | systemic inflammatory response syndrome |
| TNF | = | tumour necrosis factor |
| Abbreviations | ||
| ALI | = | acute lung injury |
| ARF | = | acute renal failure |
| CARS | = | compensated anti-inflammatory response syndrome |
| CAST | = | continuous attenuation of sepsis therapy |
| CPFA | = | coupled plasma filtration adsorption |
| CRRT | = | continuous renal replacement therapy |
| CVVH | = | continuous venovenous haemofiltration |
| CVVHD | = | continuous venovenous haemodialysis |
| HVHF | = | high-volume haemofiltration |
| ICU | = | intensive care unit |
| IL-1 | = | interleukin-1 |
| IL-6 | = | interleukin-6 |
| IL-8 | = | interleukin-8 |
| LPS | = | lipopolysaccharide |
| MARS | = | molecular adsorbent recirculating system |
| MODS | = | multiple organ dysfunction syndrome |
| MOST | = | multiple organ support therapies |
| PAF | = | platelet-activating factor |
| RRT | = | renal replacement therapy |
| SIRS | = | systemic inflammatory response syndrome |
| TNF | = | tumour necrosis factor |