Clinical benefit of high-volume hemofiltration in severe burn injury: is it removing bad humors or actually avoiding hypervolemia?

Excerpt

Recently, You et al. [1] reported that early application of high-volume hemofiltration (HVHF) reduced the incidence of sepsis, septic shock, and organ failure in patients with burns ≥ 50% total burn surface area (TBSA) and improved survival of patients with burns ≥ 80% TBSA. The benefit of HVHF was attributed to hemofiltration/adsorption of proinflammatory cytokines and other sepsis-related mediators and recovery of the patients’ immune status [1]. However, HVHF as adjuvant therapy for sepsis has previously been shown to have no significant impact on hemodynamics, short-term morbidity and mortality, and cytokine clearance [2, 3]. The results from You et al. are more remarkable because HVHF was performed with a less adsorptive dialysis membrane and a relatively low prescribed effluent rate [2, 3]. Moreover, 70–100% of the replacement solution was administered in predilution, which makes convective mediator removal less effective as compared to full postdilution [2, 3]. …