High volume and high permeability haemofiltration for sepsis: The evidence and the key issues

The use of High Volume Haemofiltration (HVHF) and High Permeability Haemofiltration (HPHF) for the treatment of sepsis remain controversial despite recent significant advances. New approaches in designing studies are mandatory to make further progress. Recent reviews indicate that inflammation is initiated and regulated by cytokines and other inflammatory mediators operating as a well integrated, self-augmenting dynamic control network. Blood filtration, with its non-specific removal of circulating cytokines and immune mudulators may be particularly effective in controlling such a network. However, the complexity of both blood filtration and sepsis must be appreciated if effective filtration therapy is to be developed. Such models may be of use in critical care to model inflammation and to assist in designing optimal filtration devices. Moving from the theory of phenomenon to study of systems will allow us to better characterize complex diseases and design more effective therapy.