Plasmapheresis and other extracorporeal filtration techniques in critical patients.

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.

Plasmapheresis and other extracorporeal filtration techniques in critical patients / Plasmaféresis y otras técnicas de depuración extracorpórea en pacientes críticos

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

[Prospective study of nosocomial infections in a medical ICU. A proposal for the generalized use of the National Nosocomial Infection Surveillance System rates]. / Estudio prospectivo de la infección nosocomial en una UCI médica. Una propuesta para el uso generalizado de las tasas del National Nosocomial Infection Surveillance System.

OBJECTIVE: To know the more relevant nosocomial infection (NI) rates in our Intensive Care Unit (ICU), risk factors associated with NI and trends in the infective flora. METHODS: During a three-month period, the cumulative incidence, density of overall incidence and device associated infection rates were determined in a total of 308 patients admitted to the medical ICU, following the recommendations of the National Nosocomial Infection Surveillance System (NNIS) in the USA. RESULTS: The cumulative incidence was 8.4 infections per 100 admissions. The density of overall incidence was 12.9 nosocomial infections per 1,000 days of ICU stay. Device-associated infection rates were: 28.9 pneumonia per 1,000 mechanical ventilation days, 5.3 urinary tract infections per 1,000 days of catheter use and 0.4 bacteremia per 1,000 days of central venous catheter. Pneumonia was the more common NI, followed by urinary tract infection. Pseudomonas aeruginosa was the microorganism recovered most frequently. The most common used antibiotics were third generation cephalosporins, followed by quinolones and macrolides. CONCLUSIONS: The use of NNIS rates is advisable because its allows to know the impact of NI on our unit and to perform comparative studies with other units of similar characteristics.