Permissive hypofiltration: an alternative view

Zaccaria Ricci,Stefano Romagnoli,Francesco Emma

doi:10.1186/cc11494

Abstract

If permissive hypercapnia is used in the context of protective ventilation for patients with acute respiratory distress syndrome, it must be highlighted that the alveoli in these patients are still exposed to significant stress. Similarly, early renal replacement therapy is not necessarily a protective therapy for acute kidney injury and loop diuretics are not necessarily harmful. It is conceivable that early initiation of 'protective' low-dose (10 ml/kg/h) continuous renal replacement therapy with zero balanced ultrafiltration in association with administration of (high dose) diuretics may help to rest the kidneys while ensuring preservation of urine output.

Highlights

If permissive hypercapnia is used in the context of protective ventilation for patients with acute respiratory distress syndrome, it must be highlighted that the alveoli in these patients are still exposed to significant stress
*Correspondence: z.ricci@libero.it 1Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy Full list of author information is available at the end of the article
Early initiation of extracorporeal ultrafiltration in patients with non-oliguric acute kidney injury (AKI) might cause decreased urine output, a clearly undesired and detrimental effect. To date, it has not convincingly been shown whether loop diuretics are harmful in the setting of AKI [5] and ‘for the vast majority of clinicians’ they are not generally discontinued in early AKI

Summary

Introduction

If permissive hypercapnia is used in the context of protective ventilation for patients with acute respiratory distress syndrome, it must be highlighted that the alveoli in these patients are still exposed to significant stress. *Correspondence: z.ricci@libero.it 1Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy Full list of author information is available at the end of the article

Results

Conclusion