The International journal of artificial organs
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Randomized Controlled Trial Comparative Study Clinical Trial
The acid-base effects of continuous hemofiltration with lactate or bicarbonate buffered replacement fluids.
To evaluate, quantify and compare the effects of continuous veno-venous hemofiltration (CVVH) with lactate or bicarbonate-buffered replacement fluids on acid-base balance. ⋯ CVVH with lactate-buffered replacement fluids induces iatrogenic hyperlactatemia. Such hyperlactatemia is associated with an acidifying effect despite a positive buffer-base balance.
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Comparative Study
Continuous renal replacement therapy: does technique influence electrolyte and bicarbonate control?
Different techniques of continuous renal replacement therapy (CRRT) might have different effects on electrolyte and acid-base control. The aim of this study was to determine whether continuous veno-venous hemodiafiltration (CVVHDF) or continuous veno-venous hemofiltration (CVVH) achieve better control of serum sodium, potassium and bicarbonate concentrations. ⋯ CRRT strategies based on different techniques have a significantly different impact on sodium and bicarbonate control.
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This study aimed to assess whether low doses of albumin in the priming solution for cardiopulmonary bypass (CPB) reduce postoperative bleeding. Three-hundred and seventy-seven patients undergoing CPB were retrospectively assigned to group A (154 patients, CPB primed with 20 ml/kg Ringer Lactate solution + 0.75 mg/kg albumin 20%) and group B (223 patients with 20 ml/kg Ringer Lactate). A significant difference was found in terms of reoperations for bleeding (group A 0/154 versus group B 9/223; P=0.033). ⋯ Platelet count after CPB was higher in group A than in group B (175 +/- 52x10(3)/microl versus 131 +/- 70x10(3)/microl; P=0.045). The amount of postoperative bleeding was 525 ml versus 680 ml at 24 hrs (P<0.001), 819 ml versus 1102 ml at 48 hrs, (P<0.001), 963 ml versus 1294 ml at 72 hrs, (P<0.045) (group A versus group B respectively). Crystalloid priming with low-dose albumin reduces postoperative bleeding.
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Continuous veno-venous hemofiltration (CVVH) appears to have a significant and variable impact on acid-base balance. However, the pathogenesis of these acid-base effects remains poorly understood. The aim of this study was to understand the nature of acid-base changes in critically ill patients with acute renal failure during continuous veno-venous hemofiltration by applying quantitative methods of biophysical analysis (Stewart-Figge methodology). ⋯ CVVH corrects metabolic acidosis in acute renal failure patients through its effect on unmeasured anions, phosphate and chloride. Such correction coupled with the effect of hypoalbuminemia, results in the development of a metabolic alkalosis after 72 hours of treatment.
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Comparative Study
Continuous venovenous hemofiltration: effects on monocyte and lymphocyte immunophenotype in critically ill patients.
The aim of this study was to test the hypothesis that continuous venovenous hemofiltration (CVVH) increases HLA-DR expression on monocytes and T lymphocytes in critically ill patients. 24 septic (SP) and 10 non-septic (NSP) medical ICU patients with acute renal failure were studied prospectively. The ultrafiltration rate was 20-30 ml.kg(-1).h(-1). The total and differential white cell counts were measured and CD3+ lymphocyte count, HLA-DR expression on CD14+ monocytes and CD3+ lymphocytes were analysed by two-colour flow cytometry before, 4 and 24 h after CVVH initiation, respectively. ⋯ The percentage of HLA-DR+/CD14+ monocytes in SP revealed no changes, whereas it decreased after 4 h of CWH in NSP (p < 0.05). The percentage of HLA-DR+/CD3+ lymphocytes in SP decreased after 24 h (p < 0.05), whereas it remained unchanged in NSP. We conclude that CWH initiation is not associated with the increase of HLA-DR expression on CD14+ monocytes and T lymphocytes in critically ill patients with acute renal failure.