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Highly Accessed Letter

Permissive hypofiltration: an alternative view

Zaccaria Ricci1*, Stefano Romagnoli2 and Francesco Emma3

Author Affiliations

1 Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy

2 Cardio-Vascular Anesthesia and Post-Surgical Intensive Care Unit, Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3 - 50134, Florence, Italy

3 Pediatric Nephrology Unit, Department of Pediatric Nephrology, Dialysis and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy

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Critical Care 2012, 16:458  doi:10.1186/cc11494

Published: 8 November 2012

Abstract

If permissive hypercapnia is used in the context of protective ventilation for patients with acute respiratory distress syndrome, it must be highlighted that the alveoli in these patients are still exposed to significant stress. Similarly, early renal replacement therapy is not necessarily a protective therapy for acute kidney injury and loop diuretics are not necessarily harmful. It is conceivable that early initiation of 'protective' low-dose (10 ml/kg/h) continuous renal replacement therapy with zero balanced ultrafiltration in association with administration of (high dose) diuretics may help to rest the kidneys while ensuring preservation of urine output.