The International journal of artificial organs
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Evidence exists that acute renal failure (ARF) independently increases mortality risk in critically-ill patients. Therefore prevention of ARF seems of paramount importance. Preservation of renal blood flow and (sufficient) perfusion pressure favourably influences the prevention of renal function deterioration in the critically-ill septic patient. ⋯ The use of diuretic agents can be harmful, as indicated by observational and cohort studies. Although mannitol flushes out intratubular casts and increases tubular flow, which is favorable in myoglobinuria or hemoglobinuria, so far no well designed clinical studies have demonstrated its efficacy in ARF In conclusion, there is currently no convincing evidence for any benefit from diuretic agents and/or (low dose) dopamine in the prevention of ARF. High quality intensive care and avoidance of harm is, therefore, the current standard of the prevention of ARF.
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HVHF can be still seen as a potent powerful immunomodulatory treatment in sepsis. Pleiotropical properties of HVHF give this treatment the possibility to affect not only SIRS but also cardiovascular compounds, clotting and post septic-insult immunoparalysis. By this multimodal approach, HVHF can alter the sepsis network through many targets. ⋯ More studies are needed to clarify the role of HVHF in hyperdynamic septic shock (with or without acute renal failure), sepsis and SIRS. They can be seen as potential indications up to now. Possible interferences with activated protein C deserve more attention as both treatments can be given sequentially in the same septic patient or even concomitantly.
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Comparative Study
Kidney failure associated with liver transplantation or liver failure: the impact of continuous veno-venous hemofiltration.
The short-term outcome of critically ill patients with kidney failure combined with severe liver failure or orthotopic liver transplantation (OLTx) is poor. We sought to test the hypothesis that, with the exclusive use of continuous veno-venous hemofilration (CVVH) with minimal heparin-anticoagulation, the short and long-term outcomes of these patients would be improved. ⋯ ARF associated with OLTx has a much better outcome than ARF without OLTx. Furthermore, management based on a conservative anticoagulation policy and CVVH as the exclusive form of renal support was associated with the best ICU, hospital and long term survival reported so far.
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Comparative Study
Evaluation of adaptive support ventilation in paralysed patients and in a physical lung model.
Evaluation of the respiratory pattern selected by the Adaptive Support Ventilation (ASV) in ventilated patients with acute, chronic respiratory failure and normal lungs and in a physical lung model. ⋯ In normal patients ASV selected a ventilatory pattern close to the physiological one, in COPD almost a high expiratory time pattern and in restrictive ones a reduced tidal volume pattern. In the model the selection was similar. In the hyperventilation test, ASV chose a balanced increase in both Vt and RR.
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Case Reports
Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting.
We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support.