Blood purification
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In the last years, publications have questioned the classical dose of 35 ml/kg, but are those studies strong enough in terms of scientific power in order to change our practice? We will try to settle some recommendations for clinicians. Manipulation of dose, porosity, and combinations have yielded promising findings. However, conclusive evidence based on randomized trials remains scarce, limiting the practical implementation in daily practice. ⋯ An ultrafiltration rate of around 35 ml/kg/h, with adjustment for predilution, can be recommended for the septic patient. Recent studies do not have enough power to change this recommendation in view of its shortcomings. Finally the recommendation is to keep going with a continuous technique, a pure continuous veno-venous hemofiltration mode, and at a dose of 35 ml/kg/h while waiting for other studies to be published.
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Achieving normohydration remains a non-trivial issue in haemodialysis therapy. Preventing the deleterious effects of fluid overload and dehydration is difficult to achieve. Objective and clinically applicable methods for the determination of a target representing normohydration are needed. ⋯ Whole-body bioimpedance spectroscopy in combination with a physiologic tissue model provides for the first time an objective and relevant target for clinical dry weight assessment.