Role of Hemofilteration in management of Burned Patients

Pathophysiology of Burn
• Burn does not cause only local skin damage but impairs also the integrity of the body with resulting functional affections of many organs and systems e.g. lungs, heart, kidneys, liver and the coagulation system. • Burn syndrome is a phenomenon consisting of a hypovolemic cardiovascular component and a cellular component. • The cellular response to burn injury falls into two categories, metabolic response and response of immune system.

Pathophysiology of Burn (cont.)

• The Immune Response to burn depends on the interaction of a series of cells (lymphocytes, macrophages and neutrophils) and a large number of soluble products of these and other cells, including interleukins, cytokines, complement proteins, and peptides.

Pathophysiology of Burn (cont.)

G Arturson, Sweden.1995

Pathophysiology of Burn (cont.)

Pathophysiology of Burn (cont.)

Haemofiltration

• The efficacy of haemofiltration in the removal of inflammatory mediators has recently been considered (last nineties).
(Hladik M.2, TymonovJ. 1, Zaoral T.2, Kadlcik M. 1. 1 Burn Centre 2 Centre for Child Dialysis and Nephrology, University Hospital Ostrava, Czech Republic. Acta, vol. 43 – 2000)

Principle of Action of Haemofiltration

• The basic principle of action of haemofiltration is the elimination of inflammatory mediators, urea, creatinine and uraemic toxins from the body. • At the same time, it makes possible the maintenance of a homeostasis and water balance.

Indications for Haemofiltration
• The indications for haemofiltration in burns are:
– renal – non-renal.

• The main indication is oliguric renal failure, in which it is possible to eliminate fluid in renal hyperhydration by haemofiltration and create more space for parenteral nutrition and drug administration. • Balancing takes place as required evenly throughout 4 hours. At the same time, a stable homeostasis is maintained and urea, creatinine, uraemic toxins and cytokines are eliminated evenly.

Indications for Haemofiltration (cont.)
• The main non-renal indications of haemofiltration are:
1. Patients with congestive heart failure not responding to diuretics. 2. Patients with sepsis, septic shock with MODS and MOF. 3. Patients with progressing SIRS before development of MODS and MOF. 4. Patients with ARDS (adult respiratory distress syndrome). 5. Refractory shifts of the electrolytes. 6. Refractory hyperpyrexia. 7. Prevention of the tumour-lysis syndrome.

Haemofiltration
• Haemofiltration has the capacity to eliminate inflammatory mediators, depending on the type of filter used, up to 30,000-50,000 Daltons (D).
Mediator Thromboxane A2 PAF Leukotriens Complement 3a Complement 5a Interleukin 1, 2 Tumor necrosis factor alpha Interleukin 6 Endotoxin Molecular weight (D) 352 524 600 10000 11200 15000 17000 25000 100000

Points to be Investigated:

• Evaluation of the role of haemofiltration in SIRS in burned patients. • Evaluation of the other indications of haemofiltration in Burned patients.

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