Inmunomodulación mediante CONVEHY(R) para COVID-19: de la tormenta al anticiclón de citoquinas / Immunomodulation using CONVEHY(R) for COVID-19: from the storm to the cytokine anticyclone

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Estudio piloto sobre el uso de la Hiperfiltración Venosa Continua para el manejo de pacientes en estado crítico con inflamación desregulada / A pilot study into the use of Continuous Venous Hyperfiltration to manage patients in a critical state with dysregulated inflammation

Introducción: Los paradigmas de la hemofiltración para manejar pacientes críticos con una respuesta inflamatoria desregulada (RID) evalúan la función renal para su inicio, adaptación y finalización. Presentamos la Hiperfiltración Venosa Continua (Protocolo CONVEHY), en el cual una membrana de adsorción inespecífica (AN69-ST-heparina anclada) se utiliza con citrato como líquido anticoagulante y de sustitución. El protocolo CONVEHY utiliza herramientas fácilmente disponibles para lograr objetivos renales y no renales, guiándose por las respuestas fisiopatológicas. Objetivos: Comparar la respuesta a la membrana AN69-ST-HA cuando se utilizó heparina (He, n = 5: protocolo estándar) o citrato (Ci, n = 6: protocolo CONVEHY) para evaluar si fuera factible un estudio mayor sobre los beneficios de este protocolo. Materiales y métodos: En un estudio retrospectivo, se evaluaron los beneficios del protocolo CONVEHY en pacientes con RID en una unidad de cuidados críticos quirúrgicos (UCCq), evaluando las puntuaciones SOFA (He 11 +/- 2,35; Ci 11 +/- 3,63; p = 0,54) y APACHE II (He 28,60 +/- 9,40; Ci 24 +/- 8,46; p = 0,93). Resultados: Hospitalización (He 35,2 +/- 16,3 noches; Ci 9 +/- 2,53; p = 0,004), hospitalización tras el alta de UCCq (He 40,25 +/- 21,82; Ci 13,2 +/- 4,09; p = 0,063), pacientes hospitalizados > 20 días (He 80%; Ci 0%; p = 0,048), días con ventilación mecánica (He 16 +/- 5,66; Ci 4 +/- 1,72; p = 0,004) y la mortalidad predicha (55,39 +/- 26,13%) frente a la real en ambos grupos (9,1%; p = 0,004). Conclusiones: El protocolo CONVEHY mejora las respuestas clínicas de los pacientes con una RID, destacando el valor potencial de realizar estudios más grandes y confirmatorios

Introduction: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. Objectives: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. Materials and methods: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 +/- 2.35; Ci 11 +/- 3.63: p=0.54) and APACHE II (He 28.60 +/- 9.40; Ci 24 +/- 8.46: p=0.93) scores. Results: Nights in hospital (He 35.2 +/- 16.3 nights; Ci 9 +/- 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 +/- 21.82; Ci 13.2 +/- 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 +/- 5.66; Ci 4 +/- 1.72: p=0.004), and the predicted (55.39 +/- 26.13%) versus real mortality in both groups (9.1%: p=0.004). Conclusions: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies

A pilot study into the use of Continuous Venous Hyperfiltration to manage patients in a critical state with dysregulated inflammation. / Estudio piloto sobre el uso de la Hiperfiltración Venosa Continua para el manejo de pacientes en estado crítico con inflamación desregulada.

INTRODUCTION: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. OBJECTIVES: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. MATERIALS AND METHODS: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 ± 2.35; Ci 11 ± 3.63: p=0.54) and APACHE II (He 28.60 ± 9.40; Ci 24 ± 8.46: p=0.93) scores. RESULTS: Nights in hospital (He 35.2 ± 16.3 nights; Ci 9 ± 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 ± 21.82; Ci 13.2 ± 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 ± 5.66; Ci 4 ± 1.72: p=0.004), and the predicted (55.39 ± 26.13%) versus real mortality in both groups (9.1%: p=0.004). CONCLUSIONS: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies.

Fibrilación auricular en paciente de 22 meses durante palatoplastia / Atrial fibrillation in a 22-month-old patient during cleft palate surgery

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