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Junma Xu, Jie Zhao, Xiaomin Jia, Gang Wang
OBJECTIVE: To explore the role of early continuous renal replacement therapy (CRRT) in bundle treatment of severe pneumonia. METHODS: Seventy severe pneumonia patients admitted to respiratory intensive care unit (RICU) of Second Affiliated Hospital of Xuzhou Medical University from January 2013 to June 2017 were enrolled. The patients were randomly divided into routine treatment group and CRRT treatment group, with 35 patients in each group. All patients were treated with bundle therapy, and those in CRRT treatment group was treated with CRRT daily on the basis of conventional bundle therapy...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Alimujiang Abulimiti, Aierhati Husaiyin, Yalikun Sailai
Systemic inflammatory response syndrome (SIRS) prevention is key to severe acute pancreatitis (SAP) treatment and the assessment of high-volume hemofiltration (HVHF) for treating SAP accompanying multiple organ dysfunction syndromes.In this prospective controlled study, 40 SAP patients were divided into 2 groups: control (n = 22, treated with fasting, decompression, and intravenous somatostatin) and HVHF (n = 18, HVHF administration in addition to the treatment in the control group) groups; and were assessed for serum and urine amylase, WBC, C-reactive protein (CRP), and hepatic and renal functions...
January 2018: Medicine (Baltimore)
S-Q Meng, W-B Yang, J-G Liu, J-Y Yuan, K Zhang, W-Y Ding, S-Q Yang, J-H Liu
OBJECTIVE: To investigate the safety and effectiveness of the application of high-volume hemofiltration (HVHF) in children with sepsis combined with acute kidney injury. PATIENTS AND METHODS: A total of 76 child patients were enrolled and randomly divided equally (n=38) into control and the observation groups respectively. The control group received conventional volume hemofiltration (the ultrafiltration rate of 35-50 ml/kg/h), and the observation group received HVHF (50-100 ml/kg/h)...
February 2018: European Review for Medical and Pharmacological Sciences
Chi-Ju Yang, Chia-Wei Wu, Chien-Chih Wu
BACKGROUND: The optimal dosing regimen of vancomycin for critically ill patients receiving continuous veno-venous hemofiltration (CVVH) remains controversial, not to mention those with concurrent use of extracorporeal membrane oxygenation (ECMO). We aimed to determine if a new dosing regimen can achieve the target vancomycin trough concentration (Ctrough) of 10-20 μg/mL in patients receiving CVVH with or without ECMO. METHODS: We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH...
February 14, 2018: Therapeutic Drug Monitoring
Derek M Culnan, Kelley Farner, Genevieve H Bitz, Karel D Capek, Yiji Tu, Carlos Jimenez, William C Lineaweaver
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries...
March 2018: Annals of Plastic Surgery
Mohamed Said Abdelsalam, Mohamed Rashwan, Mohamed Mahdi Althaf, Osman I Alfurayh, Lutfi Alkorbi, Ihab A Ibrahim
Conventional hemodialysis (HD) is the most common treatment modality used for renal replacement therapy. The concept of HD is based on the diffusion of solutes across a semipermeable membrane. Hemofiltration (HF) is based on convective transport of solutes; hemodiafiltration (HDF) is based on combined convective and diffusive therapies. Data about survival benefit of on-line HDF (OL-HDF) over high-flux HD (HF-HD) is conflicting. We conducted this study to investigate if there is a survival difference between the two treatment modalities...
January 2018: Saudi Journal of Kidney Diseases and Transplantation
Benjamin J Feinberg, Jeff C Hsiao, Jaehyun Park, Andrew L Zydney, William H Fissell, Shuvo Roy
Microelectromechanical systems (MEMS) have enabled the fabrication of silicon nanopore membranes (SNM) with uniform non-overlapping "slit shaped" pores. The application of SNM has been suggested for high selectivity of biomolecules in a variety of medical filtration applications. The aim of this study was to rigorously quantify the differences in sieving between slit pore SNM and more commonly modeled cylindrical pore membranes, including effects of the extended Derjaguin, Landau, Verwey, and Overbeek (XDLVO) interactions...
December 20, 2017: Journal of Colloid and Interface Science
Martin Siebeck, Thomas Dimski, Timo Brandenburger, Torsten Slowinski, Detlef Kindgen-Milles
Continuous renal replacement therapy is a standard treatment in critically ill patients with acute kidney injury. All CRRT techniques provide a high low-molecular weight clearance but even with hemofiltration, clearance of middle molecules is low. We investigated whether a new super high-flux hemofilter provides effective and sustained middle molecule clearance during citrate-anticoagulated continuous venovenous hemodialysis for up to 72 h. We included 14 critically ill patients with AKI-KDIGO-III in a prospective observational trial...
February 8, 2018: Therapeutic Apheresis and Dialysis
Jacob Glaser, Joseph Zeman, Stephen Noble, Nathanial Fernandez
Background: Acute kidney injury is a common complication of both civilian and military trauma. The lack of dedicated resources restrict dialysis in the forward setting. We report a case of a combat polytrauma and renal failure, using continuous arteriovenous hemofiltration to clear uremia and remove volume, allowing for ventilator liberation and safe disposition. Materials and Methods: The patient presented with traumatic lower extremity injuries and abdominal wounds and developed acute post-traumatic renal failure...
January 1, 2018: Military Medicine
M Ploner, L M Löffel, G Schüpfer, I Besmer, C J Konrad
Medication errors are frequent and a serious safety concern. Chlorhexidine (CHX) is used daily in healthcare as a disinfectant. Its accidental intravascular injection is scarcely described. Serious complications, such as acute respiratory distress syndrome (ARDS) could be a consequence. We describe a case of central venous administration of 0.1% CHX mouthwash, its potential complications and possibilities of treatment. In contrast to another case report our patient had no detectable adverse side effects...
January 19, 2018: Der Anaesthesist
Sjoerd D Meenks, Norbert A Foudraine, Paddy K C Janssen, Jos L M L le Noble
No abstract text is available yet for this article.
January 16, 2018: International Journal of Clinical Pharmacology and Therapeutics
Ben Gelbart, Renata DeMarco, Alexander David Hussey, Siva P Namachivayam, Rosemary McRae, Catherine Quinlan, Trevor Duke
OBJECTIVES: Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality. DESIGN: Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0-10,000, 10,001-50,000, > 50,000IU/L)...
January 2018: Pediatric Critical Care Medicine
Hoi-Ping Shum, King-Chung Chan, Wing-Wa Yan, Tak Mao Chan
Introduction: Extracorporeal blood purification therapies have been proposed to improve outcomes of patients with severe sepsis, with or without accompanying acute kidney injury (AKI), by removal of excessive inflammatory mediators. Materials and Methods: We report our experience with EMiC2 high-cutoff continuous venovenous hemofiltration/hemodialysis (HCO-CVVH/HD) in seven patients with AKI complicating septic shock. Results: The median treatment duration was 71 h, and the procedure was well tolerated...
November 2017: Indian Journal of Critical Care Medicine
Joachim J Bosboom, Robert B Klanderman, Maarten Zijp, Markus W Hollmann, Denise P Veelo, Jan M Binnekade, Bart F Geerts, Alexander P J Vlaar
BACKGROUND: The objective of this study was to determine the incidence, risk factors, and outcome of transfusion-associated circulatory overload (TACO) in a cohort of mixed intensive care unit patients and to compare risk factors with those for cardiac overload in the absence of transfusion. STUDY DESIGN AND METHODS: In a retrospective cohort study, patients who developed TACO were compared using multivariate analysis of two control groups: patients without pulmonary deterioration who received transfusion and patients who developed circulatory overload in the absence of transfusion...
December 13, 2017: Transfusion
Quentin Fischer, Matthias Kirsch
Refractory right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. The addition of right ventricular assist device (RVAD) may improve RV recovery and lead to improve outcomes. From February 2012 to September 2014, 44 patients received a HeartMate II. These patients were retrospectively compared in two groups according to early liberal implantation of an extracorporeal membrane oxygenation (ECMO) used as a RVAD established between a femoral vein and the pulmonary artery...
November 27, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mallika L Mendu, Megan F May, Arnaud D Kaze, Dionne A Graham, Salena Cui, Margaret E Chen, Naomi Shin, Ayal A Aizer, Sushrut S Waikar
BACKGROUND: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high morbidity, mortality and resource utilization. The type of vascular access placed for AKI-RRT is an important decision, for which there is a lack of evidence-based guidelines. METHODS: We conducted a prospective cohort study over a 16-month period with 154 patients initiated on AKI-RRT via either a non-tunneled dialysis catheter (NTDC) or a tunneled dialysis catheter (TDC) at an academic hospital...
December 4, 2017: BMC Nephrology
Felipe Quintana, María José Pezzani, Rodrigo Orozco, Jorge Dreyse, Leonardo Soto, Tomás Regueira
Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment...
August 2017: Revista Médica de Chile
Maria-Eleni Roumelioti, Gregory Trietley, Thomas D Nolin, Yue-Harn Ng, Zhi Xu, Ahmed Alaini, Rocio Figueroa, Mark L Unruh, Christos P Argyropoulos
Background: Recent meta-analyses suggest that higher removal of beta-2 microglobulin (β2M) with either high-flux (HFD) dialysis or hemodiafiltration (HDF) may be associated with decreased total and cardiovascular mortality in dialysis patients. However, there are limited data about the performance of high flux dialyzers and/or convective therapies in removing β2M. Methods: This is a random effects meta-analysis and meta-regression of data extracted from randomized controlled trials and observational studies in hemodialysis, hemofiltration and HDF regarding the efficiency of high flux dialyzers to remove β2M...
November 27, 2017: Nephrology, Dialysis, Transplantation
Laurent Ma Favié, Jean-Luc Murk, Adam Meijer, A Laura Nijstad, Erik M van Maarseveen, Maaike A Sikma
Favipiravir is a novel antiviral drug approved for influenza treatment in Japan. Little is known about favipiravir pharmacokinetics in critically ill patients. Here, we report a patient with influenza treated with favipiravir and undergoing continuous venovenous hemofiltration (CVVH) on the Intensive Care Unit of a tertiary hospital in the Netherlands. Pharmacokinetic analyses showed increased clearance and decreased plasma levels compared to healthy volunteers. CVVH has no clinically relevant contribution to total clearance...
November 29, 2017: Antiviral Therapy
Kevin K Chung, Elsa C Coates, David J Smith, Rachel A Karlnoski, William L Hickerson, Angela L Arnold-Ross, Michael J Mosier, Marcia Halerz, Amy M Sprague, Robert F Mullins, Daniel M Caruso, Marlene Albrecht, Brett D Arnoldo, Agnes M Burris, Sandra L Taylor, Steven E Wolf
BACKGROUND: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. METHODS: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States...
November 25, 2017: Critical Care: the Official Journal of the Critical Care Forum
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