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BACKGROUND & AIMS: Hypophosphatemia (HypoP) is associated with organ dysfunction and mortality. Despite its potential severe consequences, HypoP remains poorly characterized in terms of real prevalence and timing of onset. The primary objective was to determine the prevalence of HypoP defined as blood phosphate

Resume Objectifs. – Evaluer les performances des techniques de preoxygenation a volume courant pendant trois minutes (VT-3 minutes) et a huit capacites vitales en une minute (8CV) sur la fraction expiree en oxygene (FEO 2 ) et le temps de desaturation de l’hemoglobine (T95 %) chez des patientes ayant une obesite morbide. Type d’etude. – Etude prospective, randomisee. Patients et methodes. – Deux groupes de dix patientes (BMI > 40 kg/m 2 ), sans antecedent cardiorespiratoire ni difficultes d’intubation previsible ont beneficie d’une preoxygenation a VT-3 minutes ou a 8CV avec FIO 2 100 %. Les FETO 2 et PETCO 2 ont ete mesurees toutes les minutes ainsi que T95 %. Un test de Mann et Whitney a ete utilise et une valeur de p Resultats. – Il n’y avait pas de difference statistiquement significative de la FETO 2 entre les deux groupes en fin de preoxygenation [84 ± 4 % (8CV) et 88 ± 5 % (VT-3 minutes)]. Les T95 % sont comparables entre les deux groupes [176 ± 23 secondes (8CV) et 181 ± 35 secondes (VT-3 minutes)]. Le groupe 8CV avait une PETCO 2 significativement inferieure au groupe VT-3 minutes [29 ± 1 mmHg (8CV) et 36 ± 5 mmHg (VT-3 minutes)]. Conclusion. – Les techniques de preoxygenation VT-3 minutes et 8CV permettent d’obtenir des FEO 2 et un T95 % comparables chez les patientes obeses morbides. Toutefois l’innocuite de l’hyperventilation alveolaire induite par la technique 8CV n’est pas demontree.

Despite major advances in blood purification therapies, numerous questions remain. As a result, clinicians may still have some hesitation regarding the real efficacy of these techniques in sepsis as well as the best mode of hemofiltration therapy when treating patients with septic shock plus acute kidney injury (AKI) [1]. However, despite major recent therapeutic improvements, septic shock remains a leading cause of mortality in intensive care patients [2]. In addition, according to the latest available literature, it is of paramount importance to realize that the mortality rate of patients with septic AKI is much higher compared to that of patients with non-septic AKI [3], [4]. In the last decade, several milestone studies [5], [6] have shown that dose of therapy is important in terms of mortality, although recent so-called negative trials have challenged this concept. Nevertheless, a critical dose is still desirable and beyond that dose, mortality will be affected [7], [8]. We should not forget, however, that these studies carry some very important limitations [9], [10]. Regarding specifically rationale, it seems at least theoretically reasonable that effectively removing mediators from the tissue, where they are harmful, and transporting them to the central circulation must be effective. Effectiveness through only a passive transportation mechanism remains elusive. Indeed, the surface of the central blood compartment is about 30 m2, which is much smaller than the surface of the capillary blood compartment, which is about 300 m2 [11], so that passive transport between these two asymmetric compartments will not yield the same elimination rate on both sides.

Despite major recent therapeutic improvements, septic shock remains a leading cause of mortality in intensive care patients [1]. In addition, it is important to realize that the mortality rate of patients with septic acute kidney injury (AKI) is much higher than that of patients with non-septic AKI [2]. For more than a decade, it has been suggested that reducing blood cytokine levels in such patients could, at least theoretically, lead to reduced mortality [3, 4]; however, in view of the complexity of the pharmacodynamics and pharmacokinetics of cytokines, this concept is not so simple to apply. Indeed, recent studies have attempted to demonstrate that high volume hemofiltration (HVHF) with enhanced adsorption can modulate and ameliorate sepsis- induced hemodynamic instability [5]. This recently published paper [5] suggested that membranes with enhanced adsorption are the key and that increased extraction from the central circulation is sufficient to obtain a beneficial clinical effect. It seems at least theoretically reasonable that effectively removing mediators from the tissue where they are harmful, and transporting them to the central circulation must be effective. Therefore, HVHF and enhanced adsorption should work synergistically in this model. In order to consolidate this hypothesis, it seems fruitful to discuss the three separate theories that have been put forward in recent years as possible explanations for the clinical findings observed in septic patients who underwent a number of different blood purification techniques. The HVHF and hybrid techniques that are currently available to the clinician are diverse and deserve a brief description.