The International journal of artificial organs
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Continuous renal replacement therapy (CRRT) is frequently used in critically ill patients with acute renal failure and sepsis. Frequent circuit changes increase nursing workload, blood loss and costs, and also compromise achievement of the filtration rate goal. Circuit downtime is the most important factor that compromises the cumulative filtration goal. ⋯ In addition to monitoring the complication rate, the evaluation of circuit lifetime using survival analysis stratified by anticoagulation strategy is a simple and feasible means of assessing the quality of CRRT in the ICU.
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Acute renal failure (ARF) related to crush syndrome is usually treated with hemodialysis. Continuous veno-venous hemofiltration (CVVH) has seldom been adopted in this situation due to the main drawback of continuous anticoagulation. The purpose of this study was to evaluate the effectiveness and safety of regional citrate anticoagulation (RCA)-CVVH in two crush syndrome patients following the Wenchaun earthquake. ⋯ The present two crush patients have been successfully treated, but due to the limits of the small sample, it is difficult to generalize whether RCA-CVVH is safe enough for crush syndrome with a high risk of bleeding diathesis. Additional investigation with a larger number of patients is required. Fluid equilibrium, nutritional support, prevention of bleeding and infection are fundamental in this situation.
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Controlled Clinical Trial
Breakdown of the gut barrier in patients with multiple organ dysfunction syndrome is attenuated by continuous blood purification: effects on tight junction structural proteins.
Breakdown of the gut barrier increases intestinal permeability and allows movement of intraluminal contents across the mucosa, which can lead to distant organ injury and multiple organ dysfunction syndrome (MODS). Intestinal permeability is associated with alterations in cellular tight junctions involving the structural proteins occludin and zonula occludens-1 (ZO-1). The aim of this study was to investigate the effect of continuous blood purification (CBP) on gut barrier function in patients with MODS. ⋯ Breakdown of gut barrier function is present in patients with MODS and may be correlated with poor outcomes in the disease. CBP can not only improve the general conditions, as measured by the APACHE II score, but also improve gut barrier dysfunction by attenuating the breakdown and reorganization of occludin and ZO-1. This beneficial effect of CBP on gut barrier dysfunction is associated with down-regulation of iNOS.
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Controlled Clinical Trial
Improvement of immune dysfunction in patients with severe acute pancreatitis by high-volume hemofiltration: a preliminary report.
The aim of this study was to investigate the effect of high-volume hemofiltration (HVHF) on ameliorating immune dysfunction in patients with severe acute pancreatitis (SAP). ⋯ HVHF significantly reduced plasma inflammatory cytokine concentrations including those of IFN-gamma, TNF-alpha, IL-1, IL-2, IL-5, and IL-13, while it increased monocyte HLA-DR expression in patients with SAP. The association of plasma cytokine reduction and cellular immune function recovery and clinical outcome needs further investigation.
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Comparative Study
Quantifying recirculation in extracorporeal membrane oxygenation: a new technique validated.
The efficacy of veno-venous extracorporeal membrane oxygenation is limited by the phenomenon of recirculation, which is difficult to quantify. Existing measurement techniques using readily available equipment are unsatisfactory. ⋯ 1) Measurement of recirculation using oxygen content is superior to that using oxygen saturation alone, which demonstrates significant measurement bias; 2) the novel step-change technique is a sufficiently accurate technique for the measurement of recirculation in animal models.