Role of Hemofilteration uses in burn

2.  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.  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.

7.  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.  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.  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. 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.

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

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