The International journal of artificial organs
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Comparative Study Clinical Trial
Safety of citrate based hemofiltration in critically ill patients at high risk for bleeding: a comparison with nadroparin.
To study the incidence and severity of bleeding in high risk critically ill patients during high volume, citrate based continuous veno-venous hemofiltration (CVVH). ⋯ In high risk critically ill patients citrate based anticoagulation for CVVH is safe in terms of bleeding complications and transfusion requirements.
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The aim of this study was to evaluate the residual blood loss in new type single use dialyzers under the usually prevailing conditions during hemodialysis and to investigate whether or not this loss is dependent on dialyzer membrane composition or flux characteristics. ⋯ Blood loss during HD sessions due to residual blood cell volume inside dialyzers is usually slight using new type single use dialyzers but, sometimes, it can be significant and may contribute to the development or deterioration of preexisting iron deficiency anemia. The results of this study indicated that this loss can be attributed to the membrane composition of the dialyzer or to the human factor and has nothing to do with the ultrafiltration coefficient of the dialyzer.
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Review
Severe sepsis and septic shock in adult patients: an approach to management and future trends.
Severe sepsis is sepsis associated with acute organ dysfunction. Septic shock in turn, implies severe sepsis that has led to circulatory shock refractory to fluid resuscitation alone. The immediate approach to severe sepsis follows the ABCs of resuscitation: Airway, Breathing, and Circulation. ⋯ Once the patient's cardiorespiratory status is stabilized, efforts must be directed at uncovering the source and empirically yet accurately treating the infective underpinnings of severe sepsis. Following that, each of the patient's other organ systems at risk needs to be addressed: Renal/metabolic, gastrointestinal, hematological, and endocrine. Novel treatments will target both the proinflammatory and procoagulation cascades of sepsis.
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Acute liver failure (ALF) and acute on chronic liver failure (ACLF) still show a poor prognosis. MARS was used in 22 patients with ALF or ACLF to prolong patient survival for liver function recovery or as a bridge to transplantation. ⋯ MARS treatment led in all patients to an improvement of clinical, hemodynamic and neurological conditions, with significant reduction in the hepatic toxins blood level. Treatment biocompatibility and tolerance were satisfactory.
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Multicenter Study Comparative Study
A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.
To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting. ⋯ We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.