[Regional citrate anticoagulation during continuous hemofiltration in cardiosurgical patients].

Different citrate anticoagulation protocols are widely used during continuous renal replacement therapy. The investigation was to study the efficiency and safety of citrate coagulation in patients after cardiovascular interventions. Thirty-eight patients underwent continuous hemofiltration (CHF) with anticoagulation with 0.2% Prismocitrate 10/2 solution by the protocol of the company (Gambra Medical) after operations on the heart and large vessels. The clinical data, changes in azotemia, blood electrolytes and gases, as well as the mean values of citrate anticoagulation, and mean hemofilter life span were studied. The mean duration of citrate anticoagulation was 68 +/- 13.7 hours and its maximum duration wa 18 days. Predilution administration of Prismocitrate 10/2 along with postdilution replacement with routine solutions ensured the CHF dose of 35 ml/kg/hr. But for terminal conditions, volume metabolic control and effective anticoagulation were achieved without negative metabolic sequels and clinical complications. The mean life span of a hemofilter, with its mandatory replacement every 35-48 hours, was 40 hours. It is concluded that Prismocitrate 10/2 anticoagulation is an effective, safe, and easy-to-use method for CHF after cardiosurgical operations, which may be widely recommended when use of heparin is contraindicated.

[Prediction of the outcomes of renal replacement therapy for acute renal failure after cardiosurgical interventions].

The aim of the study was to evaluate the influence of different predictors on the outcomes of acute renal failure (ARF) in cardiosurgical patients. A hundred and five cases of ARF in January 1995 to August 2004 were retrospectively analyzed. Sixty-one patients received continuous renal replacement therapy (CRRT) and 44 patients had intermittent RRT (IRRT). Eighteen preoperative, perioperative, and postoperative risk factors were assessed. The overall hospital mortality was found to be 42%: 48.4% in the CRRT group and 33.3% in the IRRT group. A statistical analysis revealed 8 significant predictors of fatal outcomes: (1) the severity according to the APACHE II scale (25 +/- 1 scores); (2) the number of organ dysfunctions (3.6 +/- 0.2); (3) large-dose inotropic support; (4) artificial ventilation; (5) oliguria; (6) severe concomitant hepatic failure; (7) moderate-to-severe concomitant posthypoxic encephalopathy. CRRT improved survival in AFR associated with severe cardiorespiratory failure, oliguria, and cerebral dysfunctions. The paper discusses criteria for choosing the modes of renal replacement therapy.

[Effectiveness of plasmapheresis and its modifications in the treatment of cardiosurgical patients]. / Effektivnost' plazmafereza i ego modifikatsii v lechenii kardiokhirurgicheskikh bol'nykh.

The efficiency of plasmapheresis in the treatment of infectious complications and multiple organ dysfunctions was evaluated in 66 patients after heart surgery. Early plasmapheresis attenuated the cytokine-related systemic inflammatory response and organ damage. The optimal use of plasmapheresis modifications (membrane plasma filtration, plasma carboperfusion, cryoapheresis) improved the clinical outcomes.