[Experience of using endotoxin selective adsorption in patients with severe sepsis after open-heart surgery].

PURPOSE OF THE STUDY: To evaluate the safety and effectiveness of selective lipopolysaccharide (LPS)-adsorption therapy using polymyxin B immobilised fibre cartridges in adult patients complicated with severe sepsis after cardiac surgery. METHODS: 105 patients received extracorporeal LPS-adsorption procedures using Toraymyxin columns--PMX (Toray, Japan) in addition to the standard treatment according to the Surviving Sepsis Campaign guideline study group. For control group we selected 40 patients, comparable by PMX group in age, body weight, severity of illness, and the duration of cardiopulmonary bypass, received only standard therapy. All patients received significant doses of vasoactive drugs for hemodynamic support, mechanical ventilation and broad-spectrum antibiotics. Mean APACHE II and SOFA scores were comparable for both groups. Inclusion criteria were: clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, elevated blood plasma procalcitonin (PCT) > 2 ng ml(-1). The inclusion criteria were clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, and blood plasma procalcitonin (PCT) > 2 ng ml(-1). RESULTS: Extracorporeal treatment was administered within 24 h of a severe sepsis diagnosis. Each patient in PMX group received 2 LPS-adsorption procedures and each session of hemoperfusion lasted for 120 minutes. After the LPS-adsorption course, we noted any indices of haemodynamic improvements, including an increase in mean arterial pressure on 22% (p < 0.001), mean oxygenation index (on 24.5%, p < 0.001), normalisation of leukocytosis and a decrease in mean body temperature. After the procedures of LPS-adsorption we found the statistically significant decreasing of LPS concentrations according to LAL-test and EAA. In the control group, there were no significant changes in any of the studied parameters except body temperature. Moreover, the 28-day mortality was 42% in the study group and 65% in the control group (p = 0.032). The endotoxin adsorption procedures were not associated with any adverse reactions, and specifically no extracorporeal circuit thrombosis cases were noted. CONCLUSION: Selective LPS-adsorption is a safe and effective additional treatment method for severe sepsis patients.

[Extracorporeal methods of hematological correction in patients with acute liver insufficiency after cardiac surgery].

BACKGROUND & AIMS: Acute liver failure (ALF) usually develops in multiple organ dysfunction syndrome (MODS) and carries a high mortality risk in patients after cardiac surgery. Artificial liver support devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and adsorption (Prometheus). The aim of this study was to assess safety and efficacy of use MARS or Prometheus in elderly patients with ALF have been operated for heart diseases. METHOD: We studied 26 elder patients with ALF and MODS as postoperative complication after cardiac surgery. Patients were assigned to groups, given a combination of MARS and standard medical therapy (SMT) (MARS-group, n=9) or Prometheus and SMT (Prometheus-group, n=17). Inclusion criteria were clinical and laboratory signs of ALF: serum total bilirubin level>180 mkmol/L, 2-fold increasing serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), low serum cholinesterase and high serum ammonia levels. A variety of clinical and biochemical parameters were assessed. Primary endpoint was survival probabilities at day 28. RESULTS: MARS was used to provide 1 to 2 rounds (minimum of 6 hours each) and Prometheus was used to provide 2 to 14 rounds (minimum of 6 hours each). There were amelioration of haemodinamic instability, especially in MARS-group (increase in ADmean was 17% in MARS (p=0.005) and 10% in Prometheus-group (p=0.001)), increase in P/F ratio (12% in Prometheus-group (p=0.07)), decrease in serum total bilirubin (8.6% in MARS-group (p=0.028) and 33% in Prometheus-group (p<0.001)) and unconjugated bilirubin levels (29% in Prometheus-group (p=0.003)), also we had decreasing in serum aminotransferase levels and trend to increasing in serum cholinesterase level (12% in MARS-group (p=0.87) and 8% in Prometheus-group (p=0.86)). There were no side effects of extracorporeal liver support in both patients groups. Survival of patients with ALF, treated with MARS was 22%, in Prometheus group--35%. CONCLUSIONS: MARS and Prometheus are found to be safe and effective in patients with ALF after cardiac surgery. Further studies are needed to assess whether therapy might be beneficial in specific sublets of patients.

[Express diagnostics of endotoxaemia during postoperative period in cardiac surgical patients].

Medical technologies development and recent approaches in management of patients with septic complications during the early postoperative period present new obstacles to the laboratory service. Endotoxin is a main agent in the systemic inflammatory cascade and plays important role in sepsis pathogenesis. Recent express methods of diagnostics allow determining blood activity of endotoxin during 30-50 min. 55 ICU patients with clinical and laboratory signs of systemic inflammatory response syndrome (SIRS) after cardiac surgery were studied in the single-center prospective research. Endotoxaemia was diagnosed by express tests. Level of endotoxaemia was assessed before and after sorption in 15 patients receiving complex intensive care with selective lipopolysaccharide (LPS) adsorption. Endotoxaemia level assessment allows to define indications for different programs of intensive care in time and to assess its efficiency. Test systems for assessment endotoxin level based on the principle of interaction antigen - antibody (EAA and MACH-endotox spp.) is a most efficient for express diagnostics of endotoxaemia.

[SCD14-ST (presepsin) level monitoring in cardiac surgical patients during perioperative period].

UNLABELLED: Purpose of the study was to define prognostic ability of presepsin (sCD14-ST) as a predictor of complications in cardiac surgical patients during perioperative period. METHODS: Patients operated for acquired heart valvular diseases with cardiopulmonary bypass were involved in the study (n = 51, age 58 +/- 11 years). Following parameters were studied; demographic data, duration of cardiopulmonary bypass, time of aorta clamping, severity-of-disease by APACHE II scale before surgery, on 1st, 2nd, 3rd and 6th day after surgery, routine clinical laboratory data and sCD14-ST. RESULTS: there were no clinical laboratory evidences of inflammation before surgery in all patients. There was no difference between biomarkers in patients who had normal condition during postoperative period and in patients who had complications and/or untoward outcomes during postoperative period. Presepsin level in 6 patients (11.8%) was 543 (519-602) ng/ml, maximal 1597 ng/ml. Infection complications accrued in 19 patients (37%). Hospital mortality was 13.7% (7 patients), all cases of death was in group of patients with infection complications. Statistically significant differences in the level of presepsin and severity-of-disease by APACHE II in groups of patients with infection complications and without accrued on 1st and 2nd days of postoperative period. Optimal split point were 702 ng/ml, 8.5 points and 3.3 ng/ml. Increased postoperative level of presepsin is associated with a risk of infection complications and untoward outcomes. CONCLUSION: sCD14-ST monitoring with the use of severity-of-disease scales and recent biomarkers allow to identify patients with high risk of infection complications and untoward outcomes.

[Etiopathogenetic extracorporeal treatment of severe sepsis in patients after cardiac surgery].

The study deals with assessment of LPS-adsorption and haemodialysis with EMiC2-filters use in the complex treatment in cardio-surgery patients with heavy sepsis. 64 adult patients included in the study were divided into two groups. 26 patients of the main group with heavy sepsis (EEA > 0.6; procalcitonin level higher than 2 ng/ml) received LPS-adsorption and haemodialysis with EMiC2-filters. 38 patients of control group with heavy sepsis developed after surgeries on heart and vessels did not receive extracorporeal methods of treatment. Positive effect of combined extracorporeal treatment on haemodynamics, oxygenation, endotoxin activity decreasing, procalcitonin level, inflammatory and antiphlogistic cytokines level was identified Trend of 28-day survival increasing was indentified in the main group.

[Diagnosis and correction of thrombohemorrhagic complications in cardiosurgical patients in the early postoperative period].

The methods of the prevention, diagnosis, and correction of hemostatic disorders are discussed in cardiosurgical patients. Prevention of hemorrhages requires hemostatic history data collection that allows identification of patients with concomitant hemophilia and those, taking antithrombotic drugs. The benefits of an extended study of blood coagulation disorders are shown in neonates and babies of the first year of life due to the physiological features of the hemostatic system and the pattern of heart disease. Algorithms are proposed for the diagnosis and treatment of hemorrhagic diathesis in the early postoperative period; a complex of minor signs of surgical hemorrhage is formulated, which makes it possible to timely perform rethoracotomy and to reduce blood transfusion. Efficiency evaluation and exclusion criteria for the use of recombinant factor VIIa are given. The efficiency of using the Russian drug tranexam versus epsilon-aminocapronic acid and aprotinin in the perioperative period was evaluated. The blood coagulative system was monitored in the treatment of disseminated intravascular coagulation in multiple organ dysfunction and sepsis, which promoted the timely use of recombinant human activated protein C and human antithrombin III. A diagnostic and treatment algorithm for replacement therapy of congenital heart disease concurrent with hemophilia A is given.

[Management of patients with chronic renal failure during surgical correction of cardiovascular disease].

End-stage of chronic renal failure (CRF) is frequently associated with cardiac and vascular comorbidities requiring cardiosurgical interventions. Over 9 years, from 2000 to 2009, the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, delivered cardiosurgical care to 16 patients aged 20 to 74 years with end-stage CRF. The duration of programmed hemodialysis was 1 to 102 months. The preoperative patient preparation protocol comprised correction of anemia, hypoproteinemia, hypertension, and water-electrolyte and acid-base balances. Five patients underwent endovascular myocardial revascularization; open heart surgery was performed in one patient. Interventions under extracorporeal circulation were made in 10 other patients. Ultrafiltration was intraoperatively carried out. On-line hemodiafiltration was performed following coronary artery stenting. After open operations, renal replacement therapy (first hemodiafiltration, then hemodialysis) as daily sessions was initiated on day 2 and, when the patients were transferred to intensive care units, it was performed by the programmed hemodialysis protocol. There were no fatal outcomes at the follow-up. The key aspects of treatment success achievement and improved quality of life in patients on programmed hemodialysis are the detection of cardiovascular diseases requiring surgery, the timely referral of the patients to a cardiosurgical hospital, the meticulous pre- and perioperative management (correction of anemia, hypoproteinemia, water-electrolyte balance, use of ultrafiltration and the adequate rate of perfusion at the stage of extracorporeal circulation, and daily renal replacement therapy in the postoperative period), and continuity in the work of all specialists.

[Selective hemoperfusion in gram-negative severe sepsis of patients after cardiac surgery: a prospective randomized study].

Early in the new millennium, sepsis remains one of the most urgent problems of modern reanimatology. Endotoxin, a component of the cell wall of gram-negative bacteria is of paramount importance in the pathogenesis of sepsis. Complex intensive care for severe sepsis involves selective endotoxin hemoperfusion with Polymyxin B and Alteco LPS adsorber, which has been performed in 2 patients. This study will enable specialists to formulate their opinion as to whether it is expedient to incorporate selective endotoxin hemoperfusion into complex intensive care for severe sepsis.

[The first experience in using selective sorbents in complex intensive care of patients with infectious and septic complications after cardiac surgery].

Early in the new millennium, sepsis remains one of the most urgent problems of modern medicine as before in view of a steady tendency for a rise of morbidity rates and for stably high mortality rates in patients (from 30 to 70%). The endotoxin lipopolysaccharide (LPS) of the cell wall of gram-negative bacteria plays the most important role in the pathogenesis of sepsis. This paper assesses the first experience in using endotoxin-selective sorption technologies within complex intensive care of critically ill patients with infectious and septic complications after cardiac surgery. Group 1 comprised 6 patients undergoing Alteco LPS adsorption procedures. Group 2 included 5 patients having hemoperfusion using Polymixin B-based Toraymyxin columns. The authors'first experience in clinically using LPS adsorption suggests that it is absolutely expedient to include extracorporeal selective hemoperfusion into the complex intensive care for infectious and septic complications in patients after operations on the heart and vessels.

[Complex intensive care for acute gastroduodenal hemorrhages in patients after operations on the heart and vessels].

The purpose of the study was to define the most effective principles of intensive care for acute gastroduodenal hemorrhages in patients undergoing operations on the heart and vessels. The outcomes of 13,345 operations on the heart and vessels, performed at the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, were analyzed. Gastroduodenal hemorrhages were diagnosed in 114 patients, which amounted to 0.8% of the total number of operated patients. In the vast majority (86.8%) patients, gastroduodenal hemorrhages occurred after surgery under extracorporeal circulation. The results of medical and surgical treatment were analyzed. The medical treatment for gastroduodenal hemorrhages included intensive drug therapy and endoscopic hemostasis. The comprehensive and intensive approach to performing antiulcer therapy (concomitant use of the antisecretory agents: proton pump inhibitors, gastric protectors, and reparative agents) could reduce the incidence of recurrent bleeding and the timing of epithelization of gastrointestinal mucosal defects. Analyzing the results of the treatments has indicated that the efficiency of conservative measures significantly exceeds the beneficial effect of the treatment of gastroduodenal bleedings, including urgent abdominal surgical interventions. Emergency surgical interventions for gastroduodenal hemorrhages in cardiosurgical patients deteriorate the postoperative period and lead to an increase in postoperative morbidity, which determines the expediency of their performance only when conservative measures are ineffective. An algorithm of tactical actions has been developed for gastroduodenal hemorrhages occurring after operations on the heart and vessels.

[Hybrid technologies of renal replacement therapy in the treatment of multiple organ failure in cardiosurgical patients].

Composite reparative cardiosurgical operations frequently lead to ischemia and hypoxia of vitally important organs and systems, which may be later a cause of the multiple organ dysfunction syndrome (MODS). Up to now, after operations on the heart and vessels, the incidence of this menacing complication remains rather high. In the postoperative period, isolated acute renal failure (ARF) occurs extremely rarely; its incidence is not greater than 5-8% whereas ARF is much more frequently (as high as 90%) a component of MODS and an indicator of a patient's status. Among patients undergoing cardiac resuscitation, ARF is encountered in 20-27% of cases, 71.7% of them need replacement renal therapy (RRT). The latter should be regarded as an intermediate treatment that allows the patient to survive up to the time that native kidney function restores. Choice of an adequate and effective treatment option for acute renal dysfunction remains to be urgent. On-going discussions between the advocates of continuous RRT (CRRT) and the adherents of intermittent RRT (IRRT) are a prominent case in point. These two modalities have a variety of good and bad points. In this connection, there is an idea of developing hybrid procedures that can combine the best properties of both IRRT and CRRT in order to use them in the treatment of critically ill patients with multiply organ dysfunction and, judging from the first not numerous publications, their application has reduced the incidence of complications due to routine extracorporeal blood purifying procedures.

[Systemic inflammation after operations on the open heart: significance of a microbial factor].

The given review of the literature discusses, from the present standpoints, the pathogenetic, clinical, and diagnostic aspects of a systemic inflammatory reaction developing during cardiac surgery under extracorporeal circulation. There is evidence that endogenous infection is of importance in developing systemic inflammation during cardiosurgical interventions. Current approaches to the early diagnosis of systemic bacterial inflammation, by applying the procalcitonin test and the chromatographic mass-chromatographic technique are proposed. The prevention of systemic inflammation and its sequels is considered.

[Albumin dialysis in complex intensive therapy].

After cardiac surgery, acute hepatic failure (AHF) is a most common component of the multiple organ dysfunction syndrome (MODS) and associated with high mortality. In the past year, A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, has performed 10 postoperative MARS therapy sessions in patients with MODS caused by the development of low cardiac output. The results of the study suggest that MARS therapy has no negative impact on circulatory parameters under adequate thermoregulation monitoring. During albumin dialysis, there is a reduction in bilirubin levels by the end of a session, a significant decrease in the parameters of uremic intoxication: urea and creatinine. The studies of the values of albumin in different constituents of an extracorporeal contour have indicated the preservation of a significant gradient of the protein concentrations between the patient's blood and a dialyzing solution, which is indicative of the absence of laboratory significant permeability of a MARS filter for these molecules. Thus, the first experience in using MARD therapy suggests that it may be successfully used in patients with MODS after cardiacsurgery.

[Intensive therapy for multiple organ dysfunction in neonatal infants after cardiosurgical interventions].

This study was undertaken to evaluate the efficiency of complex intensive therapy for multiple organ dysfunction syndrome (MODS) after cardiosurgical interventions at the resuscitative and intensive care unit of the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences. In 2003-2004, MODS developed in 70 (37%) of the neonatal infants operated on the heart and vessels. The babies' age ranged from 6 hours of life to 1 month (8.3 +/- 2.1 days of life, their body weight was from 1.7 to 4.1 kg (3.0 +/- 0.49 kg). All the patients were found to have significant renal and respiratory failures. There were more than 4 (4.1 +/- 0.5) failing vital viscera. The use of phosphodiesterase (III) inhibitors in therapy for acute left ventricular insufficiency significantly improved the performance of the left heart whereas nitric oxide inhalation significantly lowered pulmonary pressure in babies with acute right ventricular insufficiency and improved oxygenation in patients with MODS. The efficiency of nitric oxide inhalation in MODS significantly increased when it was used in combination with endotracheal administration of a surfactant and high-frequency oscillatory ventilation. Peritoneal dialysis effectively replaced renal function when acute renal failure (ARF) developed. Nevertheless, the development of ARF in the pattern of MODS is a marker of high mortality (89% in ARF versus 46% in MODS without ARF).

[A present-day variant of intermitttent replacement renal therapy in patients with multiple organ failure after cardiovascular surgery]. / Sovremennyi variant intermittiruiushchei zamestitel'noi pochechnoi terapii u bol'nykh s sindromom poliorgannoi nedostatochnosti posle operatsii na serdtse i sosudakh.

The efficiency of "semi-prolonged" replacement renal therapy (RRT) was assessed in patients with multiple organ dysfunction (MOD) after cardiovascular surgery. The results of semiprolonged RRT are analyzed in 65 patients (36-69 years, mean age 52.4 +/- 15.7 years, body weight 57-105 kg, mean 79.4 +/- 21.6 kg) operated on at A. N. Bakulev Cardiovascular Surgery Center, Russian Academy of Medical Sciences. Bicarbonate hemodialysis (BHD) was carried out in 50 patients, on-line hemodiafiltration (HDF) in the rest patients. Interventions on the heart and vessels of different complexity were carried out. The results indicate that semiprolonged SRT in complex with intensive care measures notably reduced the mortality of patients with MOD and improved the survival rate in this category of patients. Semiprolonged RRT is an effective method, which can and should be used in critical patients. This method meets all the requirements to modern RRT and ensures adequate filtration of nitrous metabolism products, corrects water-electrolyte and acid base balance, allows infusion/transfusion therapy and parenteral nutrition, and has no negative impact on the hemodynamic values, which is particularly important after cardiovascular interventions.

[Peritoneal dialysis in the newborn and infants after radical correction of complex congenital heart defects]. / Peritoneal'nyi dializ u novorozhdennykh i grudnykh detei posle radikal'noi korrektsii slozhnykh vrozhdennykh porokov serdtsa.

The efficiency of peritoneal dialysis (PD) was evaluated in newborns and infants with multiple organ dysfunction (MOD) after cardiosurgery. In 1996-2001 at A. N. Bakulev Cardiovascular Surgery Center, Russian Academy of Medical Sciences, PD was used as permanent renal replacement therapy (RRT) in 19 newborns and infants aged under 1 year after radical correction of congenital heart diseases. The mean age of infants was 6.2 +/- 4.3 months, body weight 6.1 +/- 1.7 kg. Radical correction of congenital heart diseases was carried out in all patients. The immediate postoperative period was complicated by MOD in all patients. Pronounced cardiac, respiratory, and renal insufficiency was observed in all cases. The main indication for the beginning of PD was oligouria, hypervolemia, edematous syndrome with progressive cardiorespiratory insufficiency. Multiple-modality intensive care including PD resulted in positive changes in the clinical status of infants by days 4-5 of PD: hemodynamic values, gaseous exchange function of the lungs, and laboratory values improved. Hence, PD as an RRT method in newborns and infants subjected to radical cardiosurgery proved to be effective in the complex of intensive care measures for MOD. This sufficiently simple method, requiring no expensive equipment, adequately corrects hyperhydration and hypervolemia, metabolic and electrolyte disorders, and other MOD symptoms in newborns and infants.

[Significance of tissue pH in the prognosis of postoperative complications in heart surgery patients]. / Znachenie tkanevogo pH dlia prognoza posleoperatsionnykh oslozhnenii u kardiokhirurgicheskikh bol'nykh.

Ischemia of the gastrointestinal mucosa is characterized by acidosis in the submucosal layer during the majority of interventions, which necessitates monitoring of tissue pH (pHi) of the abdominal organs during aortocoronary bypass surgery and the immediate postoperative period. The pHi was measured by gastrotonometry with a nasogastral tube (Trip catheter) and Tonocap-TC200 device (Datex Engstrom, Finland); pHi was measured in 17 patients in department of intensive care on days 1 or 2 after cardiosurgical interventions with at least 120-min artificial circulation and in 23 patients during the operation. Surgical treatment consisted in correction of acquired valvular diseases, myocardial revascularization (shunting operations), and combinations of these operations. The first stage of investigation revealed a relationship between decreased pHi level to the acid values and complicated course of the postoperative period. The second stage showed that postoperative complications occurred in 27.2% cases only in patients subjected to long artificial circulation bypass (more than 120 min). The frequency of complications were 2-fold more in the patients with tissue acidosis (pHi < 7.35) during surgery than in patients with normal and alkaline pHi values. The following complications occurred: acute pancreatitis, acute peptic ulcer, acute renal and polyorgan failure. Comparative analysis of pHi and other metabolic markers of arterial blood showed a correlation between these parameters, but pHi was more specific for the diagnosis of tissue ischemia. Hence, a low invasive highly specific method of gaseous gastrotonometry helps evaluate the blood supply to abdominal organs during and after cardiac surgery with artificial circulation and predict postoperative gastrointestinal and grave systemic complications (sepsis, acute renal failure, and polyorgan failure).

[Metabolic effects of intermittent hemofiltration in patients with acute renal failure]. / Metabolicheskii éffekt intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate. MATERIALS AND METHODS: The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion. RESULTS: IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion. CONCLUSION: Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.

[The use of modified ultrafiltration in correcting complex congenital heart defects in newborn and nursing infants]. / Primenenie modifitsirovannoi ul'trafil'tratsii pri korrektsii slozhnykh vrozhdennykh porokov serdtsa u novorozhdennykh i grudnykh detei.

Modified ultrafiltration (MUF) was used in radical correction of complex congenital heart disease in 61 newborns and infants. The children were divided into 2 groups: group 1, 46 patients subjected to MUF, and group 2, 15 children operated on without MUF. Hemodynamic, hematological, biochemical, and immunological parameters were monitored. MUF in the newborns and infants helped adequately correct the hemohydrobalance due to ultrafiltration in the patient and hemoconcentration of the remaining volume in artificial ventilation device; it normalized the hematocrit values without additional infusion of donor blood. Elimination of inflammation mediators and cytokines recommends MUF for the treatment of newborns and infants.

[Evaluation of the effectiveness of continuous renal replacement therapy in critical patients after cardiovascular surgery]. / Otsenka éffektivnosti postoiannoi pochechnoi zamestitel'noi terapii u bol'nykh v kriticheskom sostoianii posle operatsii na serdtse i sosudakh.

The efficacy of continuous methods of renal substitute therapy (RST) in patients with multiple organ failure is assessed. The patients were divided in 2 groups administered different types of PST. Group 1 were 16 patients subjected to RST by peritoneal dialysis, in group 2 (n = 16) GP and/or GDP were used. Hemodynamics, hematological and biochemical values, and clearance of inflammation mediators were monitored and hemohydrobalance and complications of therapy assessed in the course of RST. Both RST methods proved to be highly effective. The possibility of differentiated use of peritoneal dialysis and GP/GDP permits an individual approach to treatment, and equally high efficacy of both methods solves the problem of treating total renal insufficiency in the majority of patients with multiple organ failure following cardiovascular surgery.