Which of the following statement(s) is/are true concerning the treatment of multisystem organ failure?

a. Forced diuresis with negative fluid balance may improve survival and acute respiratory failure

d. Continuous arteriovenous hemofiltration is preferred to intermittent hemodialysis for most critically ill patients

The important principles in the management of multiple organ failure are to avoid further episodes of local or systemic ischemia and to keep the brain viable by pharmacologic or mechanical support of the failing organs until organ recovery occurs. Respiratory failure is treated by mechanical assistance for lung inflation and ventilation and by decreasing lung edema as much as possible. Airway intubation is usually required. There is now good evidence that forced diuresis and negative fluid balance is associated with improved survival and acute respiratory failure. Cardiac failure is treated with inotropic drugs. Although ionotropic drugs are usually titrated to achieve a desired arterial blood pressure, it is more sensible to titrate ionotropes to achieve a normal oxygen delivery/oxygen consumption ratio. Pulmonary artery pressure and mixed venous saturation monitoring are essential for intelligent management of the patient with severe respiratory or cardiac failure. Adequate nutrition is also important for recovery from organ failure. Renal failure is treated by mechanical substitution of renal function. Although hemodialysis and peritoneal dialysis can serve this purpose, each has a significant drawback in the critically ill, multiple organ failure patient. Continuous arteriovenous hemofiltration (CAVH) and continuous arteriovenous hemodialysis (CAVHD) are the methods of choice for renal replacement therapy. Hepatic failure often occurs as part of the multiple organ failure syndrome but unfortunately there is no specific treatment.