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Permissive hypofiltration

Lakhmir S Chawla*, John A Kellum and Claudio Ronco

Critical Care 2012, 16:317  doi:10.1186/cc11253

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Restful organs

Michael Rodgers   (2012-11-08 13:38)  University Medical Centre Groningen email

Chawla et al make a case for "resting" the kidney. I find this a rather peculiar, non-medical term to use. I presume what they mean is to reduce the metabolism of the organ.

They claim that "rested" organs have resulted in improvement in outcome in patients with ARDS and cardiogenic shock. However, in the landmark ARDSnet trial, the "rested" group with the lower tidal volumes had in fact a higher minute ventilation compared to the control group. The improvement in outcome in this trial was therefore not due to more "rested" lungs.
In the recent IABP-SHOCK II trial there was no mortality improvement in patients with cardiogenic shock after an acute myocardial infarction placed on an intra-aortic balloon pump The "rested" group had the same mortality as the "un-rested" group.

Furthermore, no trial has ever shown furosemide to improve renal function in any cause of renal failure, despite furosemide reducing oxygen consumption in the renal tubular cells and thus "resting" the kidney.

The trial design the authors offer is interesting, but the likelihood that an outcome difference would be because of a "rested" kidney is unlikely.

Competing interests

No competing interest

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