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Shuai Ma, Yuli Lin, Bo Deng, Yin Zheng, Chuanming Hao, Rui He, Feng Ding
BACKGROUND: The endothelium is a potentially valuable target for sepsis therapy. We have previously studied an extracorporeal endothelial cell therapy system, called the endothelial bioreactor (EBR), which prolonged the survival time of endotoxemia sepsis in swine. To further study of the therapeutic effects and possible mechanisms, we established a miniature EBR system for septic rats induced by cecal ligation and puncture (CLP). METHODS: In the miniature EBR system, the extracorporeal circulation first passed through a mini-hemofilter, and the ultrafiltrate (UF) was separated, then the UF passed through an EBR (a 1-mL cartridge containing approximately 2 × 10(6) endothelial cells grown on microcarriers) and interact with endothelial cells...
December 2016: Intensive Care Medicine Experimental
Marco Sartori, Arianna Loregian, Silvana Pagni, Silvia De Rosa, Fiorenza Ferrari, Leopolda Zampieri, Mirella Zancato, Giorgio Palú, Claudio Ronco
BACKGROUND: Continuous veno-venous hemofiltration (CVVH) could affect the pharmacokinetic profile of linezolid (LZD). The aim of this study was to evaluate the LZD extracorporeal clearance using an in vitro CVVH model. METHODS: A sham miniaturized CVVH circuit (CARPEDIEM; Bellco, Mirandola, Italy) was set up with a polysulfone hemofilter (0.25 m; cutoff 50,000 Da) for 240 minutes using normal saline solution (0.9% wt/vol NaCl) and blood (n = 6) spiked with LZD. Drug solution samples were collected during CVVH at 10, 30, 60, 120, and 240 minutes...
October 2016: Therapeutic Drug Monitoring
Ondřej Zuščich, Roman Hájek, Pavel Ševčík, Vladimír Lonský, Jana Zapletalová
INTRODUCTION: This work is focused on mapping issues of hemostasis in patients during continuous renal replacement therapy, or the possible impact of the use of anticoagulants. METHODS: The study included 30 consecutive patients requiring continuous renal replacement therapy following cardiac surgery in the period of 2009 to 2012. Patients were placed into 2 branches according to the selected method of anticoagulation (regional citrate anticoagulation-RCA, unfractionated heparin UFH)...
May 16, 2016: International Journal of Artificial Organs
Clark Kensinger, Seth Karp, Rishi Kant, Benjamin W Chui, Kenneth Goldman, Torin Yeager, Edward R Gould, Amanda Buck, David C Laneve, Joseph J Groszek, Shuvo Roy, William H Fissell
An implantable hemofilter for the treatment of kidney failure depends critically on the transport characteristics of the membrane and the biocompatibility of the membrane, cartridge, and blood conduits. A novel membrane with slit-shaped pores optimizes the trade-off between permeability and selectivity, enabling implanted therapy. Sustained (3-8) day function of an implanted parallel-plate hemofilter with minimal anticoagulation was achieved by considering biocompatibility at the subnanometer scale of chemical interactions and the millimeter scale of blood fluid dynamics...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ying Lijun, Lyu Tie, Yan Jing
OBJECTIVE: To investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression. METHODS: A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days...
September 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
M G Vossen, J M Wenisch, A Maier-Salamon, A Fritsch, K Saria, C Zuba, S Jilch, R Lemmerer, M Unger, U Jaehde, W Jäger, F Thalhammer
Doripenem is a broad-spectrum parenteral carbapenem with enhanced activity against Pseudomonas aeruginosa. While the initial dosing recommendation for renally competent patients and patients undergoing continuous renal replacement therapy (cRRT) was 500 mg every 8 h (q8h), the dose for renally competent patients was updated to 1 g q8h in June 2012. There are no updated data for the dosing of patients on continuous renal replacement therapy. The original dosing regimen for cRRT patients was based on nonseptic patients, while newer publications chose comparatively low target concentrations for a carbapenem...
March 2016: Antimicrobial Agents and Chemotherapy
Farahnak Assadi, Fatemeh Ghane Shahrbaf
The dosage of drugs in patients requiring continuous renal replacement therapy need to be adjusted based on a number of variables that that affect pharmacokinetics (PK) including patient weight, CRRT modality (convention, vs. diffusion), blood and/or effluent flow, hemofilter characteristics, physiochemical drug properties, volume of distribution, protein binding and half-life as well as residual renal function. There is a paucity of data on PK studies in children with acute kidney injury requiring CRRT. When possible, therapeutic drug monitoring should be utilized for those medications where serum drug concentrations can be obtained in a clinically relevant time frame...
2016: Frontiers in Bioscience (Scholar Edition)
Jérôme Allardet-Servent, Matthias Castanier, Thomas Signouret, Rettinavelou Soundaravelou, Anne Lepidi, Jean-Marie Seghboyan
OBJECTIVE: To assess the safety and efficacy of combining extracorporeal CO2 removal with continuous renal replacement therapy in patients presenting with acute respiratory distress syndrome and acute kidney injury. DESIGN: Prospective human observational study. SETTINGS: Patients received volume-controlled mechanical ventilation according to the acute respiratory distress syndrome net protocol. Continuous venovenous hemofiltration therapy was titrated to maintain maximum blood flow and an effluent flow of 45 mL/kg/h with 33% predilution...
December 2015: Critical Care Medicine
Yoshitaka Hara, Yasuyo Shimomura, Tomoyuki Nakamura, Naohide Kuriyama, Chizuru Yamashita, Yu Kato, Taku Miyasho, Toshikazu Sakai, Shingo Yamada, Kazuhiro Moriyama, Osamu Nishida
Promising results have been reported with blood purification as adjuvant treatment; however, the immunological mechanisms remain unclear. We have been developing a new blood purification system for regulating excessive immune reactions in severe sepsis and septic shock using a granulocyte adsorbing column (Adacolumn [Ada]), and a cytokine-adsorbing hemofilter (AN69ST hemofilter [AN69]). Fresh porcine blood was circulated for 6 h in five experimental groups including Ada and AN69 to assess the effects of leukocyte adsorption, phagocytic activity and adhesiveness of granulocytes...
August 2015: Therapeutic Apheresis and Dialysis
H Hirasawa
It is widely recognized that endothelial hyperpermeability (EH) plays a pivotal role in the pathophysiology of severe sepsis and septic shock. However, very few attention has been paid to EH when we apply infusion therapy on the patients with severe sepsis and septic shock. And such infusion therapy without the consideration on EH often results in the interstitial edema which is one of the main causes of derangement in microcirculation and dysoxia in sepsis. Dysfunction of endothelial tight junction caused by inflammatory mediators is reported to be important pathophysiological factor of septic EH...
October 2015: Shock
Vittorio Scaravilli, Stefan Kreyer, Katharina Linden, Slava Belenkiy, Antonio Pesenti, Alberto Zanella, Leopoldo C Cancio, Andriy I Batchinsky
Acidification of blood entering a membrane lung (ML) with lactic acid enhances CO2 removal (VCO2ML). We compared the effects of infusion of acetic, citric, and lactic acids on VCO2ML. Three sheep were connected to a custom-made circuit, consisting of a Hemolung device (Alung Technologies, Pittsburgh, PA), a hemofilter (NxStage, NxStage Medical, Lawrence, MA), and a peristaltic pump recirculating ultrafiltrate before the ML. Blood flow was set at 250 ml/min, gas flow (GF) at 10 L/min, and recirculating ultrafiltrate flow at 100 ml/min...
September 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Sha-Xi Ouyang, Jia Fu, Ji-Tong Liu, Wen-Jian Shi, Kang-Han Liu
OBJECTIVE: This paper investigated the effects of continuous vena-venous hemofiltration on inferior vena cava reconstruction. METHOD: Totally, 11 patients were observed, vascular access in right internal jugular vein and femoral vein catheterization was established guided by ultrasound, and heparin-free continuous vena-venous hemofiltration was used to substitute for extracorporeal veno-venous bypass. Furthermore, blood pressure, central venous pressure, urine volume, blood platelet, serum albumin, renal function, serum cystatin C, CRP, TBil, AST, ALT, serum amylase, serum lipase, PLT, PT, APTT, Fig, D-mier, and adverse events were determined...
August 2016: Vascular
Tobias Nilsson, Christoffer Hansson, Andreas Wallinder, Carl-Johan Malm, Martin Silverborn, Sven-Erik Ricksten, Göran Dellgren
OBJECTIVES: Ex vivo lung perfusion (EVLP) can potentially reduce pulmonary edema. In a pig model with induced pulmonary edema, we evaluated the effect of hemofiltration (HF) during EVLP on lung function, perfusate oncotic pressure, and lung weight. METHODS: In anesthetized pigs (n = 14), pulmonary edema was induced by a balloon in the left atrium, combined with crystalloid infusion (20 mL/kg), for 2 hours. The lungs were harvested, stored cold for 2 hours, and randomized to EVLP, with or without a hemofilter (HF and noHF groups, respectively, n = 7 for each)...
February 2016: Journal of Thoracic and Cardiovascular Surgery
Alberto Zanella, Luigi Castagna, Domenico Salerno, Vittorio Scaravilli, Salua Abd El Aziz El Sayed Deab, Federico Magni, Marco Giani, Silvia Mazzola, Mariangela Albertini, Nicolò Patroniti, Francesco Mantegazza, Antonio Pesenti
RATIONALE: We developed an innovative, minimally invasive, highly efficient extracorporeal CO2 removal (ECCO2R) technique called respiratory electrodialysis (R-ED). OBJECTIVES: To evaluate the efficacy of R-ED in controlling ventilation compared with conventional ECCO2R technology. METHODS: Five mechanically ventilated swine were connected to a custom-made circuit optimized for R-ED, consisting of a hemofilter, a membrane lung, and an electrodialysis cell...
September 15, 2015: American Journal of Respiratory and Critical Care Medicine
Thomas Godet, Alain Combes, Elie Zogheib, Matthieu Jabaudon, Emmanuel Futier, Arthur S Slutsky, Jean-Michel Constantin
OBJECTIVES: To study the technical effectiveness of a novel extracorporeal CO2 removal device in removing CO2 from blood. STUDY DESIGN: Prospective animal study. ANIMALS: Five adult female healthy pigs. METHODS: Hypercapnic pigs were equipped with a low-flow CO2 removal device (PrismaLung(®), Hospal(®)) integrated on a CRRT platform. The rate of CO2 elimination was examined in vivo using a hollow fiber gas exchanger under various conditions (blood flow rates: 200, 300 and 400 mL/min; sweep gas flows: 2, 5, 10 and 50 L/min; FsO2: 0...
June 2015: Anaesthesia, Critical Care & Pain Medicine
Kenichi Kokubo, Yoshitaka Kurihara, Hiroshi Tsukao, Naoko Maruyama, Kozue Kobayashi, Toshihiro Shinbo, Minoru Hirose, Hirosuke Kobayashi
The purpose of the present study was to evaluate the adhesiveness of blood cells and the solute removal performance change of modified polysulfone membranes which have increased polyvinylpyrrolidone (PVP) coverage over their surface. Continuous hemofiltration (CHF) experiments for 24 h were carried out using an ex vivo hemofilter evaluation system to compare a modified polysulfone hemofilter (SHG) with the conventional polysulfone hemofilter (SH). The 25 and 50 % cutoff values of the sieving coefficient of dextran after CHF and the protein concentration in the filtrate was higher in SHG, indicating that less fouling occurred in the SHG membrane...
September 2015: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Hidetoshi Shiga, Hiroyuki Hirasawa, Osamu Nishida, Shigeto Oda, Masataka Nakamura, Kunihiro Mashiko, Kenich Matsuda, Nobuya Kitamura, Yoshihiko Kikuchi, Nobuo Fuke
BACKGROUND/AIM: We investigated the clinical efficacy of continuous hemodiafiltration (CHDF) with AN69ST hemofilter (AN69ST-CHDF) in patients with septic shock. MATERIALS AND METHODS: A prospective, multicenter, single-arm study was conducted. Patients with sepsis and shock defined by hyperlactemia were enrolled. The patients were treated with CHDF and in accordance with the Surviving Sepsis Campaign guidelines (SSCG). RESULTS: Thirty-four patients were enrolled...
2014: Blood Purification
Clare MacEwen, Peter Watkinson, Christopher Winearls
Whilst prolonging hemofilter (circuit) life, heparin increases bleeding risk. The impact of achieved activated partial thromboplastin time (APTT) on circuit life and bleeding risk has not been assessed in a modern critically ill cohort. Lowering filtration fraction may be an alternative means of prolonging circuit life, but is often overlooked in critical care. An observational study of 309 consecutive circuits in a general intensive care unit was conducted using a wide target APTT range. Multilevel modeling was used to predict circuit life and bleeding according to achieved APTT and filtration fraction...
June 2015: Therapeutic Apheresis and Dialysis
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
Duane C Williams, Jennifer L Turi, Christoph P Hornik, Desiree K Bonadonna, Walter L Williford, Richard J Walczak, Kevin M Watt, Ira M Cheifetz
Hemolysis can occur as a consequence of extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality and morbidity. Shear stress generated by flow through the circuit and oxygenator is believed to cause ECMO-induced hemolysis. We hypothesize that either a smaller dimension oxygenator or an in-line hemofilter will increase ECMO-associated hemolysis. Circuits were configured with a Quadrox-D Adult oxygenator (surface area 1.8 m), Quadrox-iD Pediatric oxygenator (surface area 0.8 m), or Quadrox-D Adult oxygenator with an in-line hemofilter (N = 4) and ran for 6 hours...
March 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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