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William R Clark, Francesco Garzotto, Mauro Neri, Anna Lorenzin, Marta Zaccaria, Claudio Ronco
PURPOSE: Dialysis is a highly quantitative therapy involving large volumes of both clinical and technical data. While automated data collection has been implemented for chronic dialysis, this has not been done for acute kidney injury patients treated with continuous renal replacement therapy (CRRT). METHODS: After a brief review of the fundamental aspects of electronic medical records (EMRs), a new tool designed to provide clinicians with individualized CRRT treatment data is analyzed, with emphasis on its quality assurance capabilities...
October 10, 2016: International Journal of Artificial Organs
S Figaro, U Pereira, H Rada, N Semenzato, D Pouchoulin, C Legallais
Acute and acute-on-chronic liver failure are associated to high mortality when transplantation is not possible. The lack of donors has resulted in an important demand for liver support devices. This paper describes the design and validation of a new bioartificial liver (BAL) device including fluidized bed bioreactors hosting alginate-encapsulated hepatocytes spheroids. To ensure the efficacy of the BAL and the safety of the patients, a complex extracorporeal circulation was designed to be compatible with a commercial medical device, the Prismaflex(®) monitor, already used in intensive care units...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Sebastian Hafner, Wolfgang Stahl, Theresa Fels, Karl Träger, Michael Georgieff, Martin Wepler
BACKGROUND: Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin...
2015: Journal of Intensive Care
Nigel Fealy, Leanne Aitken, Eugene du Toit, Ian Baldwin
BACKGROUND: Large multicentre studies of continuous renal replacement therapy (CRRT) in critically ill patients may influence its bedside prescription and practical application. Despite this, many aspects of CRRT may not be informed by evidence but remain a product of clinician preference. Little was known about current CRRT practice in Australia and New Zealand and it is not known if the evidence from recent studies has been integrated into practice. DESIGN AND SETTING: A prospective online survey of CRRT practice was sent to intensive care unit medical and nursing clinicians via three national databases in Australian and New Zealand ICUs in December 2013 to March 2014...
June 2015: Critical Care and Resuscitation: Journal of the Australasian Academy of 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
Bin Yu, Lixia Liu, Dong Xing, Congcong Zhao, Zhenjie Hu
OBJECTIVE: To investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment. METHODS: A prospective observational study was conducted...
May 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Ling Zhang, Ian Baldwin, Guijun Zhu, Aiko Tanaka, Rinaldo Bellomo
BACKGROUND: Automated electronic monitoring and analysis of circuit pressures during continuous renal replacement therapy (CRRT) has the potential to predict failure and allow intervention to optimise function. METHODS: Current CRRT machines can measure and store pressure readings for downloading into databases and for analysis. We developed a procedure to obtain such data at intervals of 1 minute and analyse them using the Prismaflex CRRT machine, and we present an example of such analysis...
March 2015: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Giacomo Stanzani, Rosanne E Jepson, Daniel L Chan
Continuous renal replacement therapy is an emerging technique for the treatment of acute kidney injury (AKI). Data regarding its use in cats are limited. This report describes the use of a novel continuous renal replacement therapy (CRRT) system for the treatment of AKI in a cat. A 1.3-year-old cat developed uraemic signs following the administration of a non-steroidal anti-inflammatory agent for the treatment of a suspect traumatic episode. CRRT was provided with a Prismaflex Gambro machine used in continuous venovenous haemodiafiltration mode, with an AN-69 surface-treated membrane, synthetic colloid priming and heparin anticoagulation...
June 2015: Journal of Feline Medicine and Surgery
Dmytro Khadzhynov, Torsten Slowinski, Ina Lieker, Hans-H Neumayer, Harm Peters
BACKGROUND: Regional citrate anticoagulation (RCA) is increasingly used in patients requiring continuous renal replacement therapy (CRRT). This study evaluated a new RCA protocol based on the Prismaflex® dialysis device and an isotonic citrate solution (prismocitrate) for pre-dilution continous veno-venous hemodiafiltration. METHODS: The Prismaflex®/Prismocitrate-based protocol involved an AN69ST® membrane (Prisma Flex ST100), a blood flow of 120 mL/min, 1.8 L/h Prismocitrate (10 mmol/L citrate/2 mmol/L citric acid) substitution fluid in pre-dilution mode, and 0...
May 2014: Clinical Nephrology
Seyed Amirhossein Razavi, Mary D Still, Sharon J White, Timothy G Buchman, Michael J Connor
BACKGROUND: Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration-approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines...
April 2014: Journal of Critical Care
Kelly D Heegard, Molly A Tilley, Ian J Stewart, Harcourt P Edgecombe, Jonathan B Lundy, Evan M Renz, Kevin K Chung
Adverse reactions during hemodialysis are extremely common and include a wide range of clinical presentations from mild to life threatening. We present a case of a 34 year old woman in the Burn Intensive Care Unit, who developed acute kidney injury requiring renal replacement therapy. She was placed on continuous veno-venous hemofiltration with the NxStage machine which uses a synthetic PUREMA polyethersulfone filter sterilized by gamma radiation. Within two minutes of initiating hemofiltration, the patient complained of pruritus as well as dyspnea and became flushed and agitated...
May 17, 2013: International Journal of Artificial Organs
Vimal Master Sankar Raj, Amanda Alladin, Brent Pfeiffer, Chryso Katsoufis, Marissa Defreitas, Alicia Edwards-Richards, Jayanthi Chandar, Wacharee Seeherunvong, Gwenn McLaughlin, Gaston Zilleruelo, Carolyn L Abitbol
BACKGROUND: Exertional heat stroke (EHS) results in a constellation of systemic inflammatory responses resulting in multiorgan failure and an extremely high mortality. CASE DIAGNOSIS AND TREATMENTS: We present the case of an 11-year-old obese male who suffered EHS with rhabdomyolysis and concurrent renal, pulmonary, and hepatic failure. Conventional therapies including continuous veno-venous hemodiafiltration (CVVHDF) were ineffective in preventing ongoing deterioration in clinical status...
June 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Isaac Desheng Liu, Kar-Hui Ng, Perry Yew-Weng Lau, Wee-Song Yeo, Pei-Lin Koh, Hui-Kim Yap
BACKGROUND: Initiating continuous renal replacement therapy (CRRT) in infants exposes them to the dual hemodynamic challenges of high circuit extracorporeal volumes and potential membrane reactions, in the case of acrylonitrile AN69 membranes. The use of the new Prismaflex HF20 membrane in hemodynamically unstable low-body-weight infants on inotropic support has not been reported. TREATMENT: We describe the use of the HF20 (Gambro Lundia AB, Lund, Sweden) membrane in four low-body-weight infants (2...
May 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Eugenia Yeh, Glen Brown
BACKGROUND: Continuous renal replacement therapy is used to manage fluid and solute imbalances in critically ill patients but may affect the clearance of concurrently administered drugs. The impact of continuous renal replacement therapy on pharmacokinetics has been summarized, but previous reports have included studies involving various modes of therapy, filter membranes, and brands of dialyzers, which makes it difficult to apply the recommendations to individual patients. In Canada, continuous venovenous hemodiafiltration (CVVHDF) with a Prismaflex dialyzer machine (Gambro, Saint-Léonard, Quebec) and AN69 filter membranes is the most common mode of continuous renal replacement therapy for critically ill patients...
November 2009: Canadian Journal of Hospital Pharmacy
Hoi-Ping Shum, King-Chung Chan, Wing-Wa Yan
Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is associated with a longer filter life and fewer bleeding events. Complexity of the regimen is the major hurdle preventing widespread application. This study describes a simple predilution continuous venovenous hemofiltration (CVVH) protocol utilizing a commercially prepared replacement solution containing citrate (Prismocitrate 10/2). Ten patients with acute renal failure were evaluated. The Prismaflex system was used for predilution CVVH, with Prismocitrate 10/2 running at 2500 mL/h as the main predilution replacement...
February 2012: Therapeutic Apheresis and Dialysis
Atul Kumar, Henry J Mann, Mani Keshtgarpour, Michael A Flynn, Hong Deng, Adel Rafai Far, Thomas R Parr, Susan R Moriarty
BACKGROUND: Oritavancin is an investigational lipoglycopeptide antibiotic under clinical development for the treatment of gram-positive bacterial infections. The impact of hemodialysis on plasma concentrations of oritavancin is unknown and may be important in making dosage adjustments in such patients. The present study sought to determine the clearance of oritavancin from human blood by various commercially available dialyzers in an in vitro hemodialysis model. METHODS: Three types each of low-flux (Dicea 130, F6, and Polyflux 14L) and high-flux (Revaclear, Exeltra 150, and Optiflux F160NR) dialyzers and one type of continuous renal replacement therapy (CRRT) dialyzer (Prismaflex M100) were studied...
November 2011: International Journal of Artificial Organs
Siegfried Rödl, Ingrid Marschitz, Christoph J Mache, Martin Koestenberger, Georg Madler, Gerfried Zobel
Continuous venovenous hemodiafiltration (CVVHDF) in infants is challenging due to a lack of specific and widely available technology. There is need for high precision of fluid balance and hemodynamic stability. The aim of this study is to report the first experience with the newly developed Prismaflex HF20 disposable set (HF20 set) in infants with CVVHDF. We provided safe treatment in four infants (4-14 kg) suffering from acute renal failure with the HF20 set. Treatment monitoring included patients' blood pressure, patients' weight change, and fluid balance...
September 2011: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
(no author information available yet)
The touchscreen interface used in the Gambro Prismaflex continuous renal replacement therapy (CRRT) system may occasionally become unresponsive. Gambro has developed software that addresses the problem; the software has not yet been released in the United States. Until that software is available, facilities should develop an action plan for users to follow if the problem occurs.
November 2010: Health Devices
Siegfried Rödl, Ingrid Marschitz, Christoph J Mache, Martin Koestenberger, Georg Madler, Thomas Rehak, Gerfried Zobel
PURPOSE: Renal replacement therapy (RRT) in infants is challenging due to a lack of widely available technology that is specific to this patient population. We present our initial experience with the newly developed Prismaflex HF20 disposable set used on the Prismaflex device in infants with renal failure. PATIENTS: Four infants, age 5 to 24 months, were enrolled. Overall 120 treatment sessions were performed over 300 patient-days. Treatment monitoring included patient weight change and fluid balance, treatment efficacy, number of interventions, and alarms...
January 2011: International Journal of Artificial Organs
Gian-Reto Kleger, Edith Fässler
PURPOSE: Continuous renal replacement therapy (CRRT) is frequently used in critically ill patients with acute renal failure and sepsis. Frequent circuit changes increase nursing workload, blood loss and costs, and also compromise achievement of the filtration rate goal. Circuit downtime is the most important factor that compromises the cumulative filtration goal. METHODS: We used continuous venovenous hemodiafiltration (Prismaflex, Gambro, Meyzieu Cedex, France) in our 12-bed medical intensive care unit (ICU)...
March 2010: International Journal of Artificial Organs
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