Role of Hemofilteration

in management of Burned Patients

 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.
 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.
Pathophysiology of Burn (cont.)

G Arturson, Sweden.1995
Pathophysiology of Burn (cont.)
Pathophysiology of Burn (cont.)
 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)
 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.
 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.
 Indications for Haemofiltration (cont.)

• 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.
 Haemofiltration
• 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
 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.
Thank You