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D20 Extracorporeal Techniques for Sepsis 1: Pathophysiology and Targets Educational Objectives: 1. Describe the model characteristics, the advantages and limitations of the model and how the models can be best optimized. 2. Describe the end-points for defining success of these methods. Martin Matejovic MD 10:00-11:30 Wednesday, February 15 Content Description: The uncontrolled and deregulated systemic inflammatory response to infection plays a central role in the pathophysiology of sepsis. This response is mediated by a broad spectrum of endogenous mediators leading to dysfunction in multiple organs remote <strong>from</strong> the primary infectious site. The failure of numerous clinical trials aimed at eliminating a single mediator stimulated the research to focus on non-selective removal of excessively produced mediators of sepsis. This „detoxification“ forms the theoretical basis and biological rationale for the use of hemopurification therapies as an adjunctive treatment of sepsis. While high-quality human data are lacking, much of the evidence originates <strong>from</strong> experimental studies. However, a multitude of emerging strategies that have been found effective in experimental models, failed to show any benefit in clinical studies. One of the reasons for the failure to translate the results <strong>from</strong> animals to humans could be attributed to animals models and experimental setting that do not fully mimic clinical scenario. Majority of experimental studies investigating the effectiveness of blood purification methods in the treatment of sepsis utilized hypodynamic, unresuscitated models of endotoxicosis and the treatment was started before or very early after the insult. By contrast, only a few studies were performed in hyperdynamic septic shock models aimed at replicating typical features of adequately resuscitated human septic shock. In addition, many unanswered questions remain, including the best surrogate markers to assess the efficacy of hemopurification methods and relevant biological targets. Suggested Reading: Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Crit Care. 2011;15(1):205. Ronco C, Piccinni P, Kellum J.Rationale of extracorporeal removal of endotoxin in sepsis: theory, timing and technique.Contrib Nephrol. 2010;167:25-34 Cruz D, Bellomo R, Kellum JA et al. The future of extracorporeal support. Crit Care Med. 2008;36:S243-S252. Zanotti-Cavazzoni SL, Goldfarb RD. Animal models of sepsis. Crit Care Clin 2009;25:703-19 Sykora R, Chvojka J, Krouzecky A, Radej J, Karvunidis T, Varnerova V, Novak I, Matejovic M. High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics? Intensive Care Med. 2009; 35:371-80 Doi K, Leelahavanichkul A, Yuen PS, Star RA. Animal models of sepsis and sepsis-induced kidney injury. J Clin Invest 2009;119:2868-78 99
Educational Objectives: D20 Extracorporeal Techniques for Sepsis 1: Pathophysiology and Targets Patrick M. Honoré MD 10:00-11:30 Wednesday, February 15 Special Focus on New Membranes for High Permeability Hemofiltration and New Hybrid Therapy especially highly adsorptive membranes. Patrick M HONORE, MD Educational Objectives 1) Describe the New Possibilities given with the New Membranes for High permeability hemofiltration (HPHF) that do offers to the clinician especially with the combined use of high volume hemofiltration (for Synergic action ) a new tool in order to try to effectively combat septic shock with acute kidney injury (AKI). Previous studies did show that HPHF especially with combined HVHF can removed much large quantities of mediators. 2)Describe the new possibilities given with the New Membranes for Hybrid Therapies regarding High Adsorptive Hemofiltration doing at the same time, Endotoxin Adsorption and Cytokine Adsorption. 3)Describe the rationale of attenuating the SIRS occurring during Bypass surgery with his related remoted organ damages. Content Description: 1)Reviewing the latest informations regarding High Permeability Hemofiltration and Hybrid Therapy for Experimental and Animal studies. 2)Concept of Synergy between High Permeability Hemofiltration and High Volume Hemofiltration. 3)Evaluating information regarding a newly highly adsorptive membrane. 4)Describe the rationale of attenuating the SIRS occurring during Bypass surgery with his related remoted organ damages. Suggested Reading: 1) Matson J R, Zydney AR, Honore,PM. Blood Filtration: New Opportunities and The Implications On System Biology. Critical Care and Resucitation July 2004; 6:209-218. 2) Bellomo R, Honoré PM, Matson JR, Ronco C, Winchester J, . Extracorporeal blood treatment (EBT) methods in SIRS/Sepsis (ADQI update). Review Paper based upon the ADQI III meeting on EBT in Sepsis. <strong>International</strong> Journal of Artificial organs 2005. IJAO 2005;28:450-458 3) DiCarloJV,AlexanderSR:Hemofiltration for cytokine-driven illnesses: 100
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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SPECIAL LECTURE Engineering Critica
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Nishimura R, Ornato JP, Page RL, Ri
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Do Vasoactive Drugs and Fluids Impr
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Blood Transfusions are Important fo
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Thinking Outside of the Box: A Nove
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Nursing Forum 2 Luncheon Benchmarki
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4. Mori K, Lee HT, Rapoport D, Drex
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Differential Diagnosis of AKI: Can
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Myocardial Stunning and Brain Edema
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