Role of Hemofilteration in management of Burned Patients

1
Role of Hemofilteration in management of Burned
Patients
2
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.

3
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.

4
Pathophysiology of Burn (cont.)
G Arturson, Sweden.1995
5
Pathophysiology of Burn (cont.)
6
Pathophysiology of Burn (cont.)
7
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)

8
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.

9
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.

10
Indications for Haemofiltration (cont.)

• The main non-renal indications of haemofiltration
  are
• Patients with congestive heart failure not
  responding to diuretics.
• Patients with sepsis, septic shock with MODS and
  MOF.
• Patients with progressing SIRS before development
  of MODS and MOF.
• Patients with ARDS (adult respiratory distress
  syndrome).
• Refractory shifts of the electrolytes.
• Refractory hyperpyrexia.
• Prevention of the tumour-lysis syndrome.

11
Haemofiltration

• Haemofiltration has the capacity to eliminate
  inflammatory mediators, depending on the type of
  filter used, up to 30,000-50,000 Daltons (D).

12
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.

13
Thank You