ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Meta Analysis
Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis.
Molecular Adsorbent Recirculating System (MARS) is an artificial liver support system that has been developed for patients with liver failure until the liver regains function or as a bridge to transplantation. We conducted a meta-analysis to examine the efficacy of this promising therapy. We searched MEDLINE, EMBASE, and the Cochrane Registry of Controlled Trials databases, and abstracts from the proceedings of several scientific meetings. ⋯ The limitations of this study include a small sample size, an inability to blind with significant heterogeneity among studies, and variable definitions of liver failure. The Molecular Adsorbent Recirculating System is associated with a significant improvement in total bilirubin levels and hepatic encephalopathy but has no impact on survival. Large studies are required to assess the merit of this promising therapy on patient-centered outcomes.
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Left ventricular assist device (LVAD) implantation is a widely accepted treatment for end-stage heart failure. Preoperative conditions and right ventricular dysfunction are determinant parameters that influence outcome. We investigated the effect of preoperative levosimendan treatment in LVAD patients with moderate right ventricular dysfunction and right ventricular dilatation. ⋯ During levosimendan treatment, the median NT-proBNP value in patients who survived decreased by 39%, whereas in patients who died there was an increase of 3% (p = 0.008) at 72 hours. A reduction in NT-proBNP to below 25% is a predictor of mortality with sensitivity of 100% and specificity of 70%. Levosimendan treatment improves preimplant hemodynamic performance and permits the identification of patients who will develop right ventricular failure.
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One of the greatest problems in performing continuous renal replacement therapy (CRRT) is premature coagulation of the circuit. The aim of the current study was to monitor the circuit function prospectively and analyze patient-related variables that may affect circuit life. Critically ill patients admitted to the intensive care unit of a tertiary hospital between August 2010 and August 2011 receiving continuous veno-venous hemofiltration (CVVH) with systemic heparin anticoagulation were prospectively studied. ⋯ Circuits with longer survival time appeared to have lower body temperature (37.80 ± 1.14 vs. 36.36 ± 1.09; p< 0.05), lower levels of serum ionized calcium (0.80 vs. 1.29; p< 0.05), and to be more acidic (7.233 vs. 7.377; p< 0.05). Cox regression showed that pH value and ionized calcium levels were significantly associated with circuit life. Other variables of hematocrit, albumin levels, platelet count, aPTT, PT, or dose of heparin were not significantly associated with circuit life.