Blood Purification for Acute Respiratory Failure (ALI/ARDS)

Abstract

There is no clinical evidence for the effectiveness of blood purification for treatment of ALI/ARDS. It has been demonstrated that removal of inflammatory mediators that cause lung parenchymal injury and appreciate management of lung water by continuous renal replacement therapy (CRRT) result in improvement of impaired oxygenation in ALI/ARDS patients. Therefore, a large number of studies have been performed to clarify the precise mechanisms of the validity of blood purification for treatment of ALI/ARDS. In addition, for further utilization of CRRT for ALI/ARDS, conditions in which CRRT is performed, including the method used (hemodialysis/hemodiafiltration/hemofiltration), replacement volume, duration and fiber materials of the column, have been investigated. Moreover, direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been reported to improve oxygenation in ALI/ARDS patients. Therefore blood purification has a possible role in the treatment of ALI/ARDS. Further examination must be carried out to elucidate the effectiveness of blood purification for treatment of ALI/ARDS with due consideration of effects of medications and settings of mechanical ventilation.