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Christian de Tymowski, Pascal Augustin, Hamda Houissa, Nicolas Allou, Philippe Montravers, Alienor Delzongle, Quentin Pellenc, Mathieu Desmard
Metabolic disorders and fluid overload are indications of continuous renal replacement therapy (CRRT) including continuous venovenous hemofiltration in patients on ECMO.Direct connection of CRRT machine to the ECMO circuit provides many advantages. Nevertheless, because pressures in CRRT lines relate to ECMO blood flow, high ECMO blood flow may be associated with high pressures in CRRT lines. Thus, management of CRRT pressure lines becomes challenging. We evaluated a protocol for managing high CRRT pressures...
September 20, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
R Wang, B Sun, X Y Li, H Y He, X Tang, Q Y Zhan, Z H Tong
OBJECTIVE: To investigate the predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). METHODS: Forty-two patients with severe ARF supported by VV-ECMO were enrolled from November 2009 to July 2015.There were 25 males and 17 females. The mean age was (44±18) years (rang 18-69 years). Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ⅲ, Ⅳ, Simplified Acute Physiology Score Ⅱ (SAPS) Ⅱ, Sequential Organ Failure Assessment (SOFA), ECMO net, PRedicting dEath for SEvere ARDS on VVECMO (PRESERVE), and Respiratory ECMO Survival Prediction (RESP) scores were collected within 6 hours before VV-ECMO support...
September 2016: Chinese Journal of Tuberculosis and Respiratory Diseases
J Cerdá, I Baldwin, P M Honore, G Villa, John A Kellum, Claudio Ronco
This paper reports on the continuous renal replacement therapy (CRRT) technology group recommendations and research proposals developed during the 17th Acute Dialysis Quality Initiative Meeting in Asiago, Italy. The group was tasked to address questions related to the impact of technology on acute kidney injury management. We discuss technological aspects of the decision to initiate CRRT and the components of the treatment prescription and delivery, the integration of information technology (IT) on overall patient management, the incorporation of CRRT into other 'non-renal' extracorporeal technologies such as ECMO and ECCO2R and the use of sorbents in sepsis and propose new areas for future research...
2016: Blood Purification
Pramod K Guru, Tarun D Singh, Melissa Passe, Kianoush B Kashani, Gregory J Schears, Rahul Kashyap
BACKGROUND: The role of extracorporeal membrane oxygenation (ECMO) in refractory cardiorespiratory failure is gaining momentum with recent advancements in technology. However, the need for dialysis modes such as continuous renal replacement therapy (CRRT) has also increased in the management for acute kidney injury. Establishing the exact timing of CRRT initiation in these patients from the electronic medical record is vital for automated data extraction for research and quality improvement efforts...
2016: Applied Clinical Informatics
Hyun Lee, Young Jun Ko, Jinhee Jung, Aeng Ja Choi, Gee Young Suh, Chi Ryang Chung
BACKGROUND/AIMS: This study aims to evaluate potential safety events and vital sign changes during active mobilization physical therapy (PT) in critically ill patients undergoing continuous renal replacement therapy (CRRT). METHODS: A retrospective review was performed on 29 patients who were treated with CRRT and who underwent 81 PT sessions in a medical intensive care unit at a single referral hospital; 15 patients underwent 33 sessions with passive range of motion (PROM) and 17 patients underwent 48 active mobilization PT sessions...
2016: Blood Purification
Elio Antonucci, Irene Lamanna, David Fagnoul, Jean-Louis Vincent, Daniel De Backer, Fabio Silvio Taccone
Acute kidney injury (AKI) is common in patients treated with veno-arterial (VA-) or veno-venous (VV-) extracorporeal membrane oxygenation (ECMO). In this setting, the use of continuous renal replacement therapy (CRRT) can help to optimize fluid status but may also negatively impact on patients' outcome. In contrast, the relationship between AKI, CRRT, and survival in critically ill adult patients receiving ECMO is not well defined. The institutional ECMO database (n = 162) from November 2008 to December 2013, excluding patients with ICU survival <24 hours was reviewed...
August 2016: Artificial Organs
Karl Träger, Christian Schütz, Günther Fischer, Janpeter Schröder, Christian Skrabal, Andreas Liebold, Helmut Reinelt
A 45-year-old male was admitted to our hospital with a small bowel obstruction due to torsion and was immediately scheduled for surgical intervention. At anesthesia induction, the patient aspirated and subsequently developed a severe SIRS with ARDS and multiple organ failure requiring the use of ECMO, CRRT, antibiotics, and low dose steroids. Due to a rapid deterioration in clinical status and a concurrent surge in inflammatory biomarkers, an extracorporeal cytokine adsorber (CytoSorb) was added to the CRRT blood circuit...
2016: Case Reports in Critical Care
Bijin Thajudeen, Mahmoud Kamel, Cibi Arumugam, Syed Asad Ali, Santhosh G John, Edward E Meister, Jarrod M Mosier, Yuval Raz, Machaiah Madhrira, Jess Thompson, Amy N Sussman
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used in the management of cardiopulmonary failure. Continuous renal replacement therapy (CRRT) is often added to the treatment for the correction of fluid and electrolyte imbalance in patients with acute kidney injury. Most of the literature on the use of combined ECMO and CRRT has been on pediatric patients. There are limited outcome data on the use of these combined modalities in adult patients. METHODS: This is a retrospective analysis of all the patients above the age of 18 years who underwent combined ECMO and CRRT at a tertiary care medical center during the period January 2007 to January 2012...
March 2015: International Journal of Artificial Organs
Han Chen, Rong-Guo Yu, Ning-Ning Yin, Jian-Xin Zhou
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients presenting acute cardiac and/or pulmonary dysfunctions, who are at high risk of developing acute kidney injury and fluid overload. Continuous renal replacement therapy (CRRT) is commonly used in intensive care units (ICU) to provide renal replacement and fluid management. We conducted a review to assess the feasibility, efficacy and safety of the combination of ECMO and CRRT and to illustrate the indications and methodology of providing renal replacement therapy during the ECMO procedure...
2014: Critical Care: the Official Journal of the Critical Care Forum
Bożena Seczyńska, Wiesław Królikowski, Ilona Nowak, Miłosz Jankowski, Konstanty Szułdrzyński, Wojciech Szczeklik
Extracorporeal membrane oxygenation (ECMO) is used as a salvage therapy in refractory acute respiratory distress syndrome (ARDS). Although technological progress in the ECMO systems improved the survival rate, prognosis is still significantly worsened by acute kidney injury (AKI), particularly if renal replacement therapy (RRT) is required. There are no exact guidelines recommending which techniques of ECMO and continuous RRT (CRRT) should be used for management of AKI coexisting with respiratory or circulatory failure, and how to combine them...
December 2014: Therapeutic Apheresis and Dialysis
Matthieu Schmidt, Michael Bailey, Joshua Kelly, Carol Hodgson, D James Cooper, Carlos Scheinkestel, Vincent Pellegrino, Rinaldo Bellomo, David Pilcher
PURPOSE: To assess the relationship between early daily fluid balance (FB) and 90-day outcome in adult patients treated with extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective observational study. SETTING: Tertiary referral centre for ECMO. PATIENTS: 115 patients treated with ECMO for refractory heart failure and 57 patients treated with ECMO for refractory respiratory failure. METHODS: We analysed the association between early daily FB versus hospital and 90-day mortality using multivariable logistic regression model, Cox proportional-hazards model and propensity score...
September 2014: Intensive Care Medicine
Ashley Crosswell, Matthew J Brain, Owen Roodenburg
OBJECTIVE: To determine the influence of vascular access site on continuous renal replacement therapy (CRRT) filter survival. DESIGN, SETTING AND PATIENTS: Retrospective study of the records of patients who received CRRT in The Alfred intensive care unit from June 2011 to May 2012. MAIN OUTCOME MEASURE: Filter run time. METHODS: We matched filter run time to site and type of vascular access. Mean run times were compared using a linear mixed-effects model between: temporary femoral, internal jugular (IJ) and subclavian catheters, tunnelled semipermanent IJ catheters, and extracorporeal membrane oxygenation (ECMO) circuit access...
June 2014: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Maya Hites, Antonio Maria Dell'Anna, Sabino Scolletta, Fabio Silvio Taccone
The multiple organ dysfunction syndrome (MODS) is characterized by more than one organ system failing, especially during critical illness. MODS is the leading cause of morbidity and mortality in current ICU practice; moreover, multiple organ dysfunction, especially liver and kidneys, may significantly affect the pharmacokinetics (PKs) of different drugs that are currently administered in critically ill patients. These PK alterations may either result in insufficient drug concentrations to achieve the desired effects or in blood and tissue accumulation, with the development of serious adverse events...
November 20, 2014: Advanced Drug Delivery Reviews
Alexander H Flannery, Melissa L Thompson Bastin
OBJECTIVE: To evaluate the literature for published reports regarding the efficacy of standard versus higher dosing of oseltamivir in critically ill patients with severe influenza. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1966-February 2014) using the terms oseltamivir and influenza limited to humans and adults older than 19 years. Additional articles were identified through a manual search of the references obtained from the MEDLINE search...
May 9, 2014: Annals of Pharmacotherapy
Changsheng He, Shuofei Yang, Wenkui Yu, Qiyi Chen, Juanhong Shen, Yimin Hu, Jialiang Shi, Xingjiang Wu, Jieshou Li, Ning Li
BACKGROUNDS: Extracorporeal membrane oxygenation (ECMO) has been recommended for treatment of acute, potentially reversible, life-threatening respiratory failure unresponsive to conventional therapy. Intestinal mucosal barrier dysfunction is one of the most critical pathophysiological disorders during ECMO. This study aimed to determine whether combination with CRRT could alleviate damage of intestinal mucosal barrier function during VV ECMO in a porcine model. METHODS: Twenty-four piglets were randomly divided into control(C), sham(S), ECMO(E) and ECMO + CRRT(EC) group...
2014: Journal of Cardiothoracic Surgery
Hoi-ping Shum, Arthur Ming-Chit Kwan, King-Chung Chan, Wing-Wa Yan
Patients on extracorporeal membrane oxygenation (ECMO) frequently requires continuous renal replacement therapy (CRRT). Additional anticoagulation for the CRRT circuit is usually not employed, but this may increases the risk of clot embolization, which shortens oxygenator lifespan and increases patient's risk. We report our experience on the use of regional citrate anticoagulation continuous venovenous hemofiltration (RCA-CVVH) connected to an ECMO circuit, which could be useful during low heparin or heparin-free ECMO situations...
July 2014: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Arvind Santhanakrishnan, Trent Nestle, Brian L Moore, Ajit P Yoganathan, Matthew L Paden
PURPOSE: Children requiring artificial heart-lung support through extracorporeal membrane oxygenation (ECMO) are at increased risk of developing acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is the preferred method of treatment in pediatric AKI patients. CRRT devices are noted to provide inaccurate fluid balance (FB) when operated under low flow rates seen in children. We present the design and validation of a novel pump concept to provide accurate pediatric CRRT during ECMO...
December 2013: International Journal of Artificial Organs
Jialiang Shi, Qiyi Chen, Wenkui Yu, Juanhong Shen, Jianfeng Gong, Changsheng He, Yiming Hu, Juanjuan Zhang, Tao Gao, Fengchan Xi, Jieshou Li
Pulmonary changes in veno-venous extracorporeal membrane oxygenation (VV-ECMO) are rarely determined. We compared the contribution of VV-ECMO and cannulation based on the observation of pulmonary inflammatory reaction and parenchymal construction in a porcine model of low tidal volume (VT ) ventilation. We also evaluated the effect of adding continuous renal replacement therapy (CRRT) to the ECMO circuit, because CRRT is known to reduce systemic cytokine release induced by VV-ECMO. A total of 18 pigs undergoing low-VT ventilation were randomly divided into three groups (group 1, cannulation; group 2, VV-ECMO; group 3, VV-ECMO + CRRT) and studied for 24 h...
March 2014: Artificial Organs
Juanhong Shen, Wenkui Yu, Qiyi Chen, Jialiang Shi, Yimin Hu, Juanjuan Zhang, Tao Gao, Fengchan Xi, Changsheng He, Jianfeng Gong, Ning Li, Jieshou Li
In this study, we investigated the myocardial inflammation and mitochondrial function during venovenous extracorporeal membrane oxygenation (VV ECMO) and further evaluated the effects of continuous renal replacement therapy (CRRT) on them. Eighteen piglets were assigned to the control group, ECMO group, and ECMO+CRRT group. Myocardial inflammation was assessed by the activity of myeloperoxidase (MPO), myocardial concentrations, and mRNA expression of TNF-α, IL-1β, and IL-6; mitochondrial function was assessed by activities of mitochondrial complexes I-V...
October 2013: Inflammation
Hu Yimin, Yu Wenkui, Shi Jialiang, Chen Qiyi, Shen Juanhong, Lin Zhiliang, He Changsheng, Li Ning, Li Jieshou
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been recommended for the treatment of patients with acute, potentially reversible, life-threatening respiratory failure which unresponsive to conventional therapy. But it is unclear about how ECMO affects renal tissue. METHODS: Twenty-four piglets weighing 25 to 32 kg were used in this experiment. The piglets were randomly allocated to 4 groups of 6 animals each: sham group (S group), control group (C group), VV-ECMO group (E group), VV-ECMO combined with CRRT group (EC group)...
2013: Journal of Cardiothoracic Surgery
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