Subject(s)
Noninvasive Ventilation , Pulmonary Edema , Acute Disease , Humans , Prospective Studies , Respiratory Insufficiency , Risk FactorsABSTRACT
Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients
La plasmaféresis es una técnica extracorpórea mediante la cual se procede a la eliminación de macromoléculas del plasma que se consideran mediadores de procesos patológicos. En este artículo se revisan los aspectos técnicos, las principales indicaciones en las patologías que suelen motivar ingreso en la Unidad de Cuidados Intensivos y las potenciales complicaciones de la plasmaféresis. Así mismo, se incluye una revisión de otras técnicas de depuración extracorpórea, tales como las columnas de fijación de endotoxinas y otros procedimientos que persiguen la eliminación de citoquinas o la inmunomodulación del proceso inflamatorio en el paciente crítico
Subject(s)
Humans , Plasmapheresis/methods , Critical Illness/therapy , Critical Care/methods , Blood Component Removal/methods , Hemofiltration/methods , Endotoxins/isolation & purification , Hemoperfusion/methods , Plasma Exchange/methods , Anticoagulants/therapeutic useSubject(s)
Community-Acquired Infections/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Micrococcaceae , Pneumonia, Bacterial/drug therapy , Community-Acquired Infections/diagnostic imaging , Critical Care , Female , Gram-Positive Bacterial Infections/diagnostic imaging , Humans , Microbial Sensitivity Tests , Middle Aged , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/microbiology , Pulmonary Disease, Chronic Obstructive/complications , Respiration, Artificial , Thorax/diagnostic imaging , Treatment OutcomeABSTRACT
Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients.
Subject(s)
Critical Care/methods , Hemoperfusion , Plasmapheresis , Humans , Plasmapheresis/adverse effectsSubject(s)
Critical Illness , Mannans/blood , Aspergillus , Galactose/analogs & derivatives , Glucans , Humans , beta-Glucans/bloodABSTRACT
AIM: To analyze knowledge and experience in the diagnosis and management of acute renal failure (ARF) and the use of renal replacement therapy (RRT) in different Spanish Intensive Care Units (ICUs). DESIGN: A case series with a survey conducted by the Nephro-Intensive Care Working Group of the SEMICYUC was compiled between January and November 2011. SCOPE: Spanish national ICUs. INTERVENTIONS: A survey of 28 questions with multiple and open responses. PARTICIPANTS: The survey was sent to 99 ICUs. Volunteers consisting of the medical staff belonging to the 51 ICUs that responded. Main variables of interest General characteristics of hospitals and ICUs, definitions of ARF and RRT (indications and management). RESULTS: RIFLE/AKIN scales to define ARF (47%). ARF diagnosis: plasma creatinine (80.4%), creatinine clearance (52.9%). Protocols for RRT: 72.5%. RRT in non-renal indications: 70.6%. Indications for initiation of RRT: oliguria, increased creatinine and urea. End of RRT: increased diuresis. RRT dose: 21-35 ml/kg/h (41.2%), 36-45ml/kg/h (33.3%). CONCLUSIONS: There is great variability in the ARF detection methods, and adequate incorporation of the RIFLE/AKIN systems to daily clinical practice in the ICU is still lacking. Written protocols aimed at establishing an early diagnosis of ARF are needed, based on these systems. On the other hand, there is growing interest in RRT, despite the fact that there are no definitive indications or guidelines on the use and handling of such techniques.
Subject(s)
Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Clinical Competence , Renal Replacement Therapy , Humans , Intensive Care Units , Spain , Surveys and QuestionnairesABSTRACT
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