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OBJECTIVES@#To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).@*METHODS@#A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.@*RESULTS@#Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.@*CONCLUSIONS@#Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.
Subject(s)
Humans , Child , Plasma Exchange , Mucocutaneous Lymph Node Syndrome/therapy , Continuous Renal Replacement Therapy , Renal Dialysis , Plasmapheresis , ShockABSTRACT
Objective:To investigate the therapeutic potential of therapeutic plasma exchange (TPE) combined with continuous venovenous hemofiltration (CVVH) in the treatment of children with severe sepsis and multiple organ dysfunction syndrome (MODS).Methods:It was a prospective randomized controlled study (RCT) involving 70 children with severe sepsis and MODS admitted to Anyang Maternal and Child Health Hospital from February 2019 to February 2023.According to random number table method, they were randomly divided into combination group (35 cases) and CVVH group (35 cases). Patients in the CVVH group were treated with CVVH alone, and those in the combination group were treated with TPE combined with CVVH.The antibiotic use time of the two groups was recorded and compared by the t test.The prothrombin time (PT), thrombin time (TT), partial prothrombin time (APTT), fibrinogen (FIB), and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), high mobility group protein B1 (HMGB1), Toll-like receptor 4 (TLR4) and soluble receptor (sFLT) levels before treatment and 48 h and 72 h after treatment were compared by the repeated measurement ANOVA for the overall comparison at multiple time points, and LSD- t test for pair-wise comparison.The 28-day survival of the two groups was recorded and compared by the Chi- square test. Results:The PT, TT and APTT at 48 h and 72 h after treatment were significantly lower in the combination group than those of CVVH group (all P<0.05). The FIB at 48 h[(2.15±0.42) g/L vs.(1.84±0.31) g/L]and 72 h after treatment [(2.89±0.27) g/L vs.(2.49±0.20) g/L]were significantly higher in the combination group than those of CVVH group (all P<0.05). The duration of antibiotic use in the combination group was significantly shorter than that of CVVH group [(11.33±1.16) d vs.(13.54±1.92) d, t=5.828, P<0.05]. Serum levels of IL-1β, IL-6 and TNF-α at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). Serum levels of HMGB1, TLR4 and sFLT at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). The 28-day survival of the combination group was significantly higher than that of CVVH group (94.29% vs.77.14%, χ2=4.200, P=0.040). Conclusions:TPE combined with CVVH can improve the coagulation function and inflammatory factor levels in children with severe sepsis and MODS, which may achieve therapeutic objectives by regulating the levels of HMGB1, TLR4 and sFLT, and improve the short-term prognosis.
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Objective:To investigate the volume management of intermittent veno-venous hemofiltration (IVVH) guided by critical care ultrasound in the treatment of acute kidney injury (AKI) in patients with heart failure (HF).Methods:A total of 216 patients with HF and AKI treated with IVVH in the coronary care unit (CCU) of the Third Central Hospital of Tianjin from April 2019 to June 2022 were selected as the study subjects, the patients were randomly divided into conventional guidance group (107 cases) and ultrasound guidance group (109 cases). According to the recovery of renal function, IVVH was performed 12 hours every day or 12 hours every other day. The conventional guidance group selected the conventional method to formulate IVVH prescription, and the ultrasound guidance group used critical care ultrasound to adjust the treatment parameters of IVVH on the basis of the conventional guidance group. Respiratory variation index (RVI) of inferior vena cava (IVC), right left ventricular end-diastolic transverse area ratio, early diastolic peak mitral flow velocity/mitral annulus velocity peak (E/E'), aortic flow velocity time integral (VTI), cardiac output (CO), bilateral lung ultrasound B-line range, bilateral renal interlobar arteries resistance index (RI) were recorded before and 3, 6, 9 hours after each treatment. The net dehydration rate was adjusted in real time according to the comprehensive results. Urine volume, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood B-type brain natriuretic peptide (BNP), β 2-microglobulin (β 2-MG) and cystatin C (Cys C) levels of patients in both groups were monitored before and 3, 7 and 10 days after initial treatment, and renal function recovery and clinical prognostic indexes of patients in both groups were recorded. Results:The dehydration rate of the ultrasound guidance group was slow at the beginning of IVVH, and gradually increased after 6 hours, and the overall dehydration rate was significantly slower than that of the conventional guidance group. In the ultrasound guidance group using critical care ultrasound, the RVI gradually increased, the right left ventricular end-diastolic area ratio gradually decreased, the E/E' ratio gradually decreased, and the range of B-line of bilateral lungs gradually decreased, RI of bilateral renal interlobar arteries decreased. At 3, 7 and 10 days after the first IVVH, renal function related indexes in both groups were significantly improved compared with before treatment, and the decline rate of β 2-MG and Cys C in the ultrasound guidance group was faster than that in the conventional guidance group at early (3 days) [β 2-MG (mg/L): 3.69±1.31 vs. 3.99±1.45, Cys C (mg/L): 2.91±0.95 vs. 3.14±0.96, both P < 0.05], urine volume, SCr and eGFR at 7 days were also significantly improved compared with the conventional guidance group [24-hour urine volume (mL): 1 128.23±153.92 vs. 1 015.01±114.18, SCr (μmol/L): 145.86±32.25 vs. 155.64±28.42, eGFR (mL/min): 50.26±11.24 vs. 46.51±10.61, all P < 0.05]. The time of SCr recovery, the time of reaching polyuria, the total time of IVVH treatment, the time of non-invasive mechanical ventilation and the time of living in CCU in the ultrasound guidance group were shorter than those in the conventional guidance group. The incidences of hypotension, long-term RRT, incidence of major cardiovascular adverse event (MACE) and at 28-day mortality were all lower than those in the conventional guidance group. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the ultrasound guidance group was significantly lower than that in the conventional guidance group (Log-Rank test: χ 2 = 3.903, P = 0.048). Conclusion:The strategy of IVVH guided by critical care ultrasound in the treatment of HF with AKI has unique advantages.
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Objective:To explore the effect of continuous large-volume hemofiltration combined with somatostatin on the prognosis of patients with acute severe pancreatitis.Methods:A total of 106 patients with acute severe pancreatitis who were treated in the People′s Hospital of Xinjiang Uygur Autonomous Region from October 2019 to October 2021 were enrolled retrospectively and they were divided into drug group (53 cases) and filtration group (53 cases) according to different treatment methods. The patients in the drug group were given somatostatin instillation on the basis of routine treatment, and the patients in the filtration group were given continuous large-volume hemofiltration therapy on the basis of the drug group. The serum amylase level, clinical efficacy, clinical indicators and prognosis were compared between the two groups.Results:After treatment for 3 d and 1 week, the levels of serum amylase in the drug group were lower than those in the filtration group: (385.62 ± 15.57) U/L vs.(426.83 ± 18.21) U/L, (110.75 ± 7.68) U/L vs. (162.74 ± 9.12) U/L, there were statistical differences ( P<0.05). The total effective rate in the filtration group was higher than that in the drug group: 90.57%(48/53) vs. 75.47%(40/53), χ2 = 4.28, P<0.05. The hospitalization time, gastrointestinal decompression time and recovery time of bowel sounds in the filtration group were shorter than those in the drug group: (17.21 ± 4.01) d vs. (20.56 ± 4.57) d, (5.46 ± 1.56) d vs. (7.98 ± 1.79) d, (5.43 ± 2.11) d vs. (6.78 ± 2.54) d, there were statistical differences ( P<0.05). After treatment for 3 d and 1 week, the scores of gastrointestinal function and acute physiology and chronic health assessment (APACHE) Ⅱ in the filtration group were lower than those in the drug group: after treatment for 3 d: (1.64 ± 0.35) scores vs. (1.89 ± 0.41) scores, (23.42 ± 2.71) scores vs. (27.62 ± 3.01) scores; after treatment for 1 week: (0.67 ± 0.21) scores vs. (1.01 ± 0.32) scores, (9.78 ± 1.21) scores vs. (15.62 ± 1.58) scores, there were statistical differences ( P<0.05). After treatment for 28 d, the fatality rate in the filtration group was lower than that in the drug group: 5.66%(3/53) vs. 20.75%(11/53), χ2 = 5.27, P<0.05. Conclusions:Bedside continuous bulk hemofiltration with somatostatin in the treatment of severe acute pancreatitis can effectively reduce the serum amylase level, promote the recovery of gastrointestinal function, improve the clinical symptoms and prognosis.
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Resumen: Los fosfuros metálicos son efectivos plaguicidas empleados para proteger granos de cultivo durante su almacenaje y transportación; sin embargo, su uso puede extenderse al combate de plagas en sitios donde se almacenan, procesan y consumen alimentos, tal es el caso de mercados, restaurantes e incluso en el hogar. Presentamos el caso de una paciente que en un intento suicida ingirió una cantidad potencialmente letal de fosfuro de zinc, a la cual fue posible otorgarle un abordaje temprano basado en la terapia de soporte, descontaminación gástrica, administración de aceite de oliva y el empleo de hemofiltración como técnica para incrementar la eliminación, con lo cual el desenlace resultó favorable. Ello sugiere que el inicio temprano de la descontaminación y la instauración oportuna de la terapia de sostén son capaces de atenuar el impacto de dichos xenobióticos en el organismo. Adicionalmente, en nuestra paciente no se observó un factor protector con el uso de aceite de oliva, pero sí con el uso de hemofiltración. Pese a ello, son necesarios estudios comparativos antes de considerar la hemofiltración como terapia de elección en pacientes intoxicados por fosfuros metálicos.
Abstract: Metal phosphides are effective pesticides used to protect grains during storage and transportation, however, their use can be extended to combat pests in places where food is stored, processed, and consumed, such markets, restaurants and even at home. We present the case of a patient who in a suicide attempt ingested a potentially lethal amount of zinc phosphide, who was given an early approach based on supportive therapy, gastric decontamination, administration of olive oil, and the use of hemofiltration as a technique to increase elimination, with which the outcome was favorable. The above suggests that the early initiation of decontamination and the opportune establishment of maintenance therapy are capable of attenuating the impact of these xenobiotics in the organism. Additionally, in our patient a protective factor was not observed with the use of olive oil, but with the use of hemofiltration. Despite this, comparative studies are necessary before considering hemofiltration as the therapy of choice in patients poisoned by metal phosphides.
Resumo: Os fosfetos metálicos são pesticidas eficazes utilizados na proteção de grãos durante o armazenamento e transporte, porém, seu uso pode ser estendido para combater pragas em locais onde os alimentos são armazenados, processados e consumidos, como mercados, restaurantes e até mesmo em casa. Apresentamos o caso de um paciente que em tentativa de suicídio ingeriu uma quantidade potencialmente letal de fosfeto de zinco, ao qual foi realizada abordagem precoce baseada em terapia de suporte, descontaminação gástrica, administração de azeite de oliva e uso de hemofiltração como técnica para aumentar a eliminação, com o qual o resultado foi favorável. Isso sugere que o início precoce da descontaminação e o estabelecimento oportuno da terapia de manutenção são capazes de atenuar o impacto desses xenobióticos no organismo. Além disso, em nosso paciente não foi observado fator protetor com o uso de azeite, mas sim com o uso de hemofiltração. Apesar disso, estudos comparativos são necessários antes de considerar a hemofiltração como terapia de escolha em pacientes intoxicados por fosfetos metálicos.
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La Insuficiencia Renal Aguda (IRA), es sin dudas una de las complicaciones más frecuentes que puede presentar el paciente crítico; la cual se define como la disminución en la capacidad que tienen los riñones para eliminar productos nitrogenados de desechos. En las unidades de cuidados críticos la causa de las mismas puede ser multifactorial y se relaciona con el fallo multiorgánico. El presente trabajo es un relato de experiencia, un trabajo descriptivo de experiencias de la terapia en reemplazo renal continuo, acompañado además de recolección bibliográfica, cuyo objetivo principal es la capacitación en el tratamiento de las insuficiencias renales en los pacientes críticos con la terapia de reemplazo renal continuo. Para abordar esta temática, se conformó un equipo multidisciplinario en el mes de Abril del año 2021, entre los servicios de Unidad de Cuidados Crítico y el Servicio de Nefrología, en donde se desarrolló un plan de capacitación de manera virtual para abordar el tratamiento a los pacientes con fallo renal, el cual contó además con la disertación y capacitación de personal altamente calificados en el tema, para posteriormente realizar un entrenamiento teórico-práctico en el servicio de Hemodiálisis del Sanatorio Allende de Nueva Córdoba, en la técnica de conexión y desconexión de catéteres de hemodiálisis, en el cual asistieron un total de 26 enfermeros del área de Terapia Intensiva de ambas sedes con el fin de aprender la técnica específica que se aplicará en los pacientes que serán sometidos a hemofiltración venovenosa continua[AU]
Acute Renal Insufficiency (AKI) is undoubtedly one of the most frequent complications that critical patients may present; which is defined as the decrease in the ability of the kidneys to eliminate nitrogenous waste products. In critical care units, their cause can be multifactorial and is related to multiorgan failure.The present work is a report of experiences, a descriptive work of experiences of continuous renal replacement therapy, accompanied by a bibliographic collection, whose main objective is training in the treatment of renal insufficiency in critical patients with replacement therapy. continuous kidney. To address this issue, a multidisciplinary team was formed in April 2021, between the services of the Critical Care Unit and the Nephrology Service, where a training plan was developed virtually to address the treatment of patients. patients with kidney failure, which also included the dissertation and training of highly qualified personnel on the subject, to subsequently carry out theoretical-practical training in the Hemodialysis service of the Allende Sanatorium in Nueva Córdoba, in the connection and disconnection technique of hemodialysis catheters, which was attended by a total of 26 nurses from the Intensive Care area of both sites in order to learn the specific technique that will be applied to patients who will undergo continuous venovenous hemofiltration[AU]
A Insuficiência Renal Aguda (LRA) é, semdúvida, uma das complicaçõesmaisfrequentes que os pacientes críticos podemapresentar; que é definida como a diminuição da capacidade dos rins de eliminar produtosresiduais nitrogenados. Em unidades de terapia intensiva, sua causa pode ser multifatorial e está relacionada à falência de múltiplos órgãos. O presente trabalho é um relato de experiências, umtrabalhodescritivo de experiências de terapia renal substitutiva contínua, acompanhado de umlevantamento bibliográfico, cujo objetivo principal é a capacitação no tratamento da insuficiência renal em pacientes críticos com terapia substitutiva renal. Para abordar essaquestão, uma equipe multidisciplinar foi formada em abril de 2021, entre os serviços da Unidade de Terapia Intensiva e o Serviço de Nefrologia, onde foi desenvolvido um plano de treinamento virtualmente para abordar o tratamento de pacientes com insuficiência renal, que incluiutambém o dissertação e treinamento de pessoal altamente qualificado no assunto, para posteriormente realizar treinamento teórico-prático no serviço de Hemodiálise do Sanatório Allende em Nueva Córdoba, na técnica de conexão e desconexão de cateteres de hemodiálise, que contoucom a participação de um total de 26 enfermeiros da área de Terapia Intensiva de ambos os locais para conhecer a técnica específica que será aplicada aos pacientes que ser ãosubmetidos à hemofiltração venovenosa contínua[AU]
Subject(s)
Humans , Renal Dialysis , Education, Distance , Critical Care , Renal Insufficiency , Continuous Renal Replacement Therapy , Inservice Training , Multiple Organ FailureABSTRACT
Objective:To investigate the effects of sustained low-efficiency hemodialysis combined with hemoperfusion on routine blood indicators and inflammatory factors in patients with sepsis-induced acute kidney injury.Methods:Eighty-six patients with sepsis-induced acute kidney injury who received treatment in Yantai Laiyang Central Hospital from April 2018 to April 2021 were included in this study. They were randomly divided into an observation group and a control group, with 43 cases in each group. All patients received conventional supportive treatment. The control group received continuous renal replacement therapy and the observation group received sustained low-efficiency dialysis combined with hemoperfusion. Before and after treatment, routine blood indicators [hemoglobin (Hb), white blood cell (WBC) count, platelet (PLT) count, albumin (Alb)], inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), procalcitonin PCT)], renal function indicators [serum creatinine (Scr), blood urea nitrogen (BUN)], The Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of hospital stay, and 28-day mortality rate were compared between the two groups.Results:Before treatment, there were no significant differences in Hb, WBC count, PLT count, Alb, IL-6, CRP, TNF-α, PCT, Scr, BUN, and APACHE II score between the two groups ( t = 0.04, 0.95, 0.23, 0.67, 1.54, 0.75, 0.98, 0.23, 1.04, 0.44, 0.07, all P > 0.05). After treatment, serum levels of Hb and Alb in each group were significantly increased compared with those before treatment. After treatment, serum levels of Hb and Alb in the observation group were (105.29 ± 15.80) g/L, (39.25 ± 7.87) g/L, respectively, which were significantly higher than (98.55 ± 12.93) g/L and (33.38 ± 7.29) g/L in the control group ( t = 2.16, 3.58, both P < 0.05). After treatment, WBC count, PLT count, IL-6, CRP, TNF-α, PCT, Scr, and BUN levels, and APACHE II score in each group were significantly decreased compared with those before treatment. After treatment, WBC count, PLT count, IL-6, CRP, TNF-α, PCT, Scr, and BUN levels, and APACHE II score in the observation group were (10.28 ± 1.87) × 10 9/L, (129.32 ± 14.79) × 10 9/L, (59.00 ± 12.77) μg/L, (22.41 ± 5.01) mg/L, (28.41 ± 4.77) μg/L, (18.41 ± 2.78) μg/L, (162.01 ± 21.04) μmol/L, (7.38 ± 1.17) mmol/L, (11.28 ± 3.60) points, respectively, which were significantly lower than (12.32 ± 2.27) × 10 9/L, (137.39 ± 18.30) × 10 9/L, (79.35 ± 14.36) μg/L, (29.31 ± 6.37) mg/L, (34.33 ± 5.38) μg/L, (22.32 ± 3.35) μg/L, (184.06 ± 24.03) μmol/L, (9.87 ± 1.66) mmol/L, (14.65 ± 3.38) points in the control group ( t = 4.54, 2.24, 6.94, 5.58, 5.39, 5.89, 4.52, 8.03, 4.47, all P < 0.05). The length of intensive care unit stay in the observation group was significantly shorter than that in the control group [(11.63 ± 2.18) days vs. (14.07 ± 2.71) days, t = 4.60, P < 0.05]. There was no significant difference in 28-day mortality rate between the two groups ( χ2 = 1.36, P > 0.05). Conclusion:Sustained low-efficiency dialysis combined with hemoperfusion is effective on sepsis-induced acute kidney injury. The combined therapy can improve routine blood indicators, inhibit inflammatory reactions, promote renal function recovery, and decrease the mortality rate to a certain degree.
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Objective:To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance.Methods:A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO 2), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients. Results:Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO 2, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (μg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (μmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO 2 levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ2 = 7.288, P = 0.007]. Conclusion:Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.
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RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios (AU).
ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results (AU).
Subject(s)
Humans , Male , Renal Replacement Therapy/methods , Leptospirosis/complications , Patients , Therapeutics/methods , Radiography, Thoracic/methods , Intensive Care UnitsABSTRACT
Severe acute pancreatitis (SAP) is a disease with dangerous course and poor prognosis, and although medical technology keeps improving over the years, the mortality rate of SAP remains high. As the latest achievement in the field of blood purification over the past 30 years, continuous blood purification has made great achievements in the treatment of SAP; however, there are still many controversies, and further studies are needed to explore therapeutic effect and mechanism. This article reviews the studies on continuous blood purification in the treatment of SAP in recent years and elaborates on its therapeutic mechanism, treatment mode, and treatment effect.
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Background and Purpose : Patients who undergo cardiac and thoracic vascular surgery are known to have a high risk of developing acute kidney injury (AKI). The incidence of post-operative acute renal failure and the utility of continuous hemodiafiltration (CHDF) for acute renal failure following cardiovascular surgery was determined. Subjects and Methods : Of the 321 subjects who underwent cardiac and thoracic vascular surgery accompanied by an open thoracotomy from January 2014 to August 2017, 303 patients were included in this study after excluding those who received maintenance dialysis and those treated with PCPS. Patients were grouped based on the GFR classification of CKD severity (preoperative eGFR values : G1 : ≥90, G2 : <90, G3a : <60, G3b : <45, G4 : <30, G5 : <15) and patient records were retrospectively examined. Results : The total incidence of AKI was 30.7%. In comparison with G1 and G2, the AKI incidence rate was significantly higher (p<0.01) in G3a, G3b, G4, and G5 patients who displayed preoperative renal dysfunction. Upon multivariate analysis, preoperative eGFR values were shown to be a predictor of post-operative AKI avoidance with a cutoff value of 56 ml/min/1.73 m2 (odds ratio = 4.104, AUC = 0.6954). The post-operative CHDF introduction rate was 3.6%. After introduction of CHDF, patient urine volume and body blood pressure significantly increased (p < 0.01). In 2 cases, a rapid increase of urine volume (2.5 ml/kg/h, 1.8 ml/kg/h) was observed within 1 h after the induction of CHDF. Conclusions : A high rate of post-operative AKI onset occurs in cardiac and thoracic surgery cases. Upon early introduction of post-operative CHDF, prompt recovery of renal function and stabilization of circulatory dynamics can be expected.
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In order to further standardize the clinical technical operation of blood purification related to organ transplantation, experts in the fields of organ transplantation and nephrology organized by Branch of Organ Transplantation of Chinese Medical Association have formulated this specification from the perspectives of technical operation specifications of vascular access, hemodialysis, peritoneal dialysis, hemofiltration, plasma exchange and immunoadsorption.
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BACKGROUND: Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy that anesthesiologists can encounter in the operation room, and patients with DMD are susceptible to complications such as rhabdomyolysis, hyperkalemic cardiac arrest, and hyperthermia during the perioperative period. Acute onset of hyperkalemic cardiac arrest is a crisis because of the difficulty in achieving satisfactory resuscitation owing to the sustained hyperkalemia accompanied by rhabdomyolysis. CASE: We here report a case of a 13-year-old boy who had multiple leg fractures and other trauma after a car accident and who had suffered from acute hyperkalemic cardiac arrest. He was refractory to cardiopulmonary resuscitation and showed sustained hyperkalemia. With extracorporeal membrane oxygenation and in-line hemofiltration, he recovered from repeated cardiac arrest and hyperkalemia. CONCLUSIONS: Combining ECMO and in-line hemofiltration might be a safe and effective technique for refractory hyperkalemic cardiac arrest and rhabdomyolysis in patients with DMD.
Subject(s)
Adolescent , Humans , Male , Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Fever , Heart Arrest , Hemofiltration , Hyperkalemia , Leg , Muscular Dystrophies , Muscular Dystrophy, Duchenne , Orthopedics , Perioperative Period , Resuscitation , RhabdomyolysisABSTRACT
The treatment of severe acute pancreatitis (SAP) is a difficult clinical problem.Hemofiltration has been used in the treatment of SAP for more than 20 years.Hemofiltration can clear excessively activated inflammatory factors of blood and block systemic inflammatory response syndrome (SIRS),while maintaining water-electrolyte balance.It plays an more and more important role in the treatment of SAP.At the same time,the application of hemofiltration in the treatment of SAP is also controversial and requires further study.This paper will summarize recent advances in hemofiltration for SAP so as to achieve better application of hemofiltration in clinical practice.
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Objective To simplify regional citrate anticoagulation(RCA) in continuous veno-venous hemofiltration (CVVH) with a calcium-containing replacement solution for children after congenital heart surgery.Methods The clinical data of 20 children with RCA in CVVH after congenital heart surgery were retrospectively analyzed.All cases were divided into two groups:the traditional group(12 cases) using a calcium-free replacement solution and the modified group(8 cases) using a calcium-containing replacement solution.The blood gas data,plasma ionic calcium,total calcium/ionic calcium ratio,circuit survival time,calcium supplement and the number of adjustments of replacement fluid formula were compared between the two groups after CVVH.Results During RCA-CVVH,serum HCO3-,pH,systemic ionized calcium,and the ratio of total calcium / ionic calcium were higher than those before RCA-CVVH,but all in normal range.There was no significant difference in circuit survival time between two groups [(50.5 ± 2.3) h vs.(48.8 ± 4.7)h,respectively,P >0.05].Calcium supplementation in the traditional group was significantly higher than that in the modified group[2.5% calcium chloride supplementation was(0.43 ±0.11) ml/(kg-h) in the traditional group and(0.13 ± 0.17) ml/(kg-h) in the modified group].The number of replacement solution adjustment was (2.7 ± 1.1) times in traditional group,while the modified group did not change the replacement formula.Conclusion RCA using a calcium-containing replacement fluid in hemofiltration,can reduce the supplement of calcium and the times of the replacement solution adjustment,which is easy to operate.It can be used safely,effectively and conveniently in CVVH children after congenital heart surgery.
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Objective To design a mathematical calculation model for better understanding and grasping the logical problem of replacement fluid and citric acid anticoagulant infusion in continuous veno-venous hemofiltration (CVVH). Methods ① Parameter definition: A, B, and T were respectively called the main part of pre-replacement fluid, 5% sodium bicarbonate solution, and 4% sodium citrate infused before filter. And a and b were respectively called the main part of post-replacement fluid, and 5% sodium bicarbonate solution infused after filter. ② Logic conversion:The liquid in back terminal (Z) was artificially divided into two parts. One (X) was the original residual plasma after filtration. The second (Y) was the part excluding the plasma, including the left part of pre-replacement fluid with sodium citrate, and the post-replacement fluid. ③The mathematical formulas of liquid volume and electrolyte concentration at X, Y and Z in unit time were listed according to the principle of CVVH and the screening coefficient of filter for different substances. ④The calculation formulas were entered into Excel form, and a mathematical calculation model was made, and a simulation calculation with examples was carried out. Results An Excel model was established by inserting the calculation formulas of volume, electrolyte, and total calcium at X, Y and Z. And it was found that the concentration of Na+, K+, Cl-, HCO3- at Y point remained unchanged only when A, B and (or) a, b was kept in same side and proportion even with the change of blood flow and other parameters without sodium citrate as anticoagulant. Once any of the parameters (such as blood flow, replacement fluid volume, etc.) were adjusted in other infusion methods (such as different ratios, different directions of the same year, etc.), the calculation results at Y would vary, and the electrolyte concentration at Z would change accordingly. A change of dilution model or parameter would result in the change of the electrolyte concentration at Y and Z with sodium citrate as anticoagulant. The concentration of total calcium scarcely changed no matter in what model and parameters. Conclusions All kinds of infusion ways could be included in the Excel model. The infusion results of all kinds of infusion matching could be intuitively evaluated. It is helpful for the medical staff to make a logical analysis and risk prediction in CVVH.
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Objective To investigate the effect of anisodamine combined with blood purification on pulmonary fibrosis and levels of serum matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase 1 (TIMP1) in patients with paraquat poisoning.Methods From March 2013 to February 2017,84 patients with paraquat poisoning admitted to our hospital were enrolled in the observation group (anisodamine +blood purification) or control group (blood purification),42 cases in each group.The curative effect,indexes related to pulmonary fibrosis,serum MMP-9 and TIMP1 levels were compared between the two groups.The incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and intensive care uni (ICU) admission time were recorded.Results There was significant difference (P < 0.05) in the total effective rate (88.1% vs 69.0%) and the high-resolution computed tomography (CT) score after 7 days of treatment (8.4 ± 0.9 vs 12.3 ± 1.4) between the observation group and the control group.At the same time,the serum levels of hyaluronic acid and type Ⅳ collagen in the two groups showed an upward trend with significant difference (P < 0.05).After 1 day of treatment,the serum levels of MMP-9 and TIMP1 in the observation group reached a peak,then gradually decreased,with significant difference (P <0.05).The incidence of ALI/ARDS in the observation group and the control group (11.9% vs 31.0%)and the duration of ICU treatment [(10.2 ± 3.2) d vs (13.2 ± 2.8) d].Conclusions For patients with acute paraquat poisoning,the combination of anisodamine and blood purification can down-regulate the expressions of MMP-9 and TIMP1 and delay the progression of pulmonary fibrosis,thus improving the clinical therapeutic effect.
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Objective@#To investigate the effect of anisodamine combined with blood purification on pulmonary fibrosis and levels of serum matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase 1 (TIMP1) in patients with paraquat poisoning.@*Methods@#From March 2013 to February 2017, 84 patients with paraquat poisoning admitted to our hospital were enrolled in the observation group (anisodamine + blood purification) or control group (blood purification ), 42 cases in each group. The curative effect, indexes related to pulmonary fibrosis, serum MMP-9 and TIMP1 levels were compared between the two groups. The incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and intensive care uni (ICU) admission time were recorded.@*Results@#There was significant difference (P<0.05) in the total effective rate (88.1% vs 69.0%) and the high-resolution computed tomography (CT) score after 7 days of treatment (8.4±0.9 vs 12.3±1.4) between the observation group and the control group. At the same time, the serum levels of hyaluronic acid and type Ⅳ collagen in the two groups showed an upward trend with significant difference (P<0.05). After 1 day of treatment, the serum levels of MMP-9 and TIMP1 in the observation group reached a peak, then gradually decreased, with significant difference (P<0.05). The incidence of ALI/ARDS in the observation group and the control group (11.9% vs 31.0%) and the duration of ICU treatment [(10.2±3.2)d vs (13.2±2.8)d].@*Conclusions@#For patients with acute paraquat poisoning, the combination of anisodamine and blood purification can down-regulate the expressions of MMP-9 and TIMP1 and delay the progression of pulmonary fibrosis, thus improving the clinical therapeutic effect.
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Objective To observe the effect of different hemodialysis methods on calcium and phosphorus metabolism in uremic patients .Methods 130 patients with uremia who underwent hemodialysis were divided into maintenance hemodialysis group ( HD group ) and maintenance hemodialysis filtration group ( HDF group ) according to different dialysis methods ,65 cases in each group .The HD group was treated with maintenance hemodialysis .The HDF group received high -throughput polysulfone membrane dialyzer ,the two groups received dialysis for 6 months. The Ca2+,serum phosphorus (P3+),parathyroid hormone (iPTH),1,25 dihydroxyvitamin D[1,25(OH)2D] were measured before and after treatment in both two groups .Results The total effective rate was 76.92% in the HD group and 84.62%in the HDF group.There was no statistically significant difference between the two groups (χ2 =1.25,P=0.535).After treatment,Ca2+in the two groups was statistically significantly increased compared with before treatment(t=4.841,P=0.00;t=8.600,P=0.00),and Ca2+in the HDF group was higher than that in the HD group (t=4.410,P=0.00).After treatment,P3+in the two groups was significantly decreased compared with before treatment(t=14.580,P=0.00;t=19.260,P=0.00),and P3+in the HDF group was lower than that in the HD group(t=6.500,P=0.00).After treatment,iPTH in the two groups was significantly decreased compared with before treatment(t=58.800,P=0.00;t=65.730,P=0.00),and iPTH in the HDF group was significantly lower than that in the HD group (t=8.380,P=0.00).After treatment,the 1,25(OH)2D levels in the two groups were significantly higher than those before treatment (t=18.970,P=0.00;t=21.650,P=0.00),and 1,25(OH)2D level in HDF group was significantly higher than HD group (t=3.250,P=0.001).Conclusion Compared with maintenance hemodialysis , maintenance hemodialysis filtration has more positive effect on calcium and phosphorus metabolism in uremic patients ,and it has significant effect on lowering blood phosphorus and increasing serum calcium level,so it is more suitable for clinical use .
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Objective To comprehensively evaluate the clinical efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on acute paraquat poisoning (APP).Methods Literatures of Chinese and English randomized controlled trials (RCTs), case control and cohort study on HP combined with CVVH in the treatment of APP from the PubMed, Embase, Wanfang, and CNKI up to November 2017 were enrolled (the subjects were > 16 years old). The obtained literatures were strictly screened and evaluated in quality, and data such as mortality, the life time of dead patients, inefficiency rate, incidence of multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS) were extracted. Meta-analysis was performed by RevMan 5.3. Results Twenty-one studies were included with 2222 subjects, among whom 976 subjects were in HP combined with CVVH group (experimental group) and 1246 subjects in HP group (control group). Compared with control group, the mortality in experimental group were significantly decreased [43.77% (362/827) vs. 55.26% (604/1093), odds ratio (OR) =0.68, 95% confidential interval (95%CI) = 0.56-0.82,P = 0.0001], the life time of death patients was significantly prolonged [mean difference (MD) = 4.63, 95%CI = 2.60-6.66,P < 0.00001], incidence of MODS [25.93% (70/270) vs. 55.36% (155/280),OR = 0.26, 95%CI = 0.14-0.49,P< 0.0001], and incidence of ARDS [30.37% (82/270) vs. 51.07%(143/280),OR = 0.42, 95%CI = 0.30-0.61,P < 0.00001], and inefficiency rate [8.72% (13/149) vs. 34.64% (53/153),OR=0.17, 95%CI = 0.09-0.34, P < 0.00001] were significantly reduced. Funnel chart showed that except the publication bias of mortality rate, there were less publication bias about other indicators among studies.Conclusion HP combined with CVVH can significantly reduce the mortality of patients with APP compared with HP alone on the whole, prolong the life time and reduce the occurrence of MODS and ARDS, thus improving the treatment efficiency.