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2.
Medicine (Baltimore) ; 98(38): e17284, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568012

RESUMO

BACKGROUND: This study will assess the efficacy and safety of blood purification (BP) for severe pancreatitis (SP) and acute respiratory distress syndrome (ARDS). METHODS: We will search the following electronic databases of Ovid MEDLINE, EMBASE, Web of Science, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANGFANG from inception to the present without language restriction. A systematic review and data synthesis will be carried out of randomized controlled trials of BP for the treatment of patients with SP and ARDS. RevMan 5.3 software will be used for statistical analysis. RESULTS: This systematic review will evaluate the efficacy and safety of BP for the treatment of patients with SP and ARDS. The primary outcome includes respiratory indexes, blood biochemical and inflammatory factors. The secondary outcomes consist of complications, sepsis, abdominal hemorrhage, renal failure, length of hospital stay, and mortality. CONCLUSION: This study will provide up-to-date evidence of BP for the treatment of patients with SP and ARDS. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139467.


Assuntos
Hemofiltração , Pancreatite/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Doença Aguda , Hemofiltração/métodos , Humanos , Pancreatite/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Resultado do Tratamento
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 725-730, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315731

RESUMO

OBJECTIVE: To design a mathematical calculation model for better understanding and grasping the logical problem of replacement fluid and citric acid anticoagulant infusion in continuous veno-venous hemofiltration (CVVH). METHODS: (1) Parameter definition: A, B, and T were respectively called the main part of pre-replacement fluid, 5% sodium bicarbonate solution, and 4% sodium citrate infused before filter. And a and b were respectively called the main part of post-replacement fluid, and 5% sodium bicarbonate solution infused after filter. (2) Logic conversion: The liquid in back terminal (Z) was artificially divided into two parts. One (X) was the original residual plasma after filtration. The second (Y) was the part excluding the plasma, including the left part of pre-replacement fluid with sodium citrate, and the post-replacement fluid. (3) The mathematical formulas of liquid volume and electrolyte concentration at X, Y and Z in unit time were listed according to the principle of CVVH and the screening coefficient of filter for different substances. (4) The calculation formulas were entered into Excel form, and a mathematical calculation model was made, and a simulation calculation with examples was carried out. RESULTS: An Excel model was established by inserting the calculation formulas of volume, electrolyte, and total calcium at X, Y and Z. And it was found that the concentration of Na+, K+, Cl-, HCO3- at Y point remained unchanged only when A, B and (or) a, b was kept in same side and proportion even with the change of blood flow and other parameters without sodium citrate as anticoagulant. Once any of the parameters (such as blood flow, replacement fluid volume, etc.) were adjusted in other infusion methods (such as different ratios, different directions of the same year, etc.), the calculation results at Y would vary, and the electrolyte concentration at Z would change accordingly. A change of dilution model or parameter would result in the change of the electrolyte concentration at Y and Z with sodium citrate as anticoagulant. The concentration of total calcium scarcely changed no matter in what model and parameters. CONCLUSIONS: All kinds of infusion ways could be included in the Excel model. The infusion results of all kinds of infusion matching could be intuitively evaluated. It is helpful for the medical staff to make a logical analysis and risk prediction in CVVH.


Assuntos
Ácido Cítrico/administração & dosagem , Hemofiltração/métodos , Modelos Teóricos , Terapia de Substituição Renal , Anticoagulantes/administração & dosagem , Humanos , Citrato de Sódio/administração & dosagem
4.
Int J Antimicrob Agents ; 54(3): 351-355, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279852

RESUMO

The aim of this study was to describe the population pharmacokinetics of ticarcillin during extended daily diafiltration (EDDf) in critically ill patients with acute kidney injury. Blood samples were collected from critically ill patients prescribed ticarcillin during one to two dosing intervals during which EDDf was performed. Plasma samples were measured using a validated ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. Concentration-time data were analysed using a population pharmacokinetics approach with Pmetrics®. A total of 53 blood samples were collected from six critically ill patients (three male). The mean ± standard deviation patient age, weight and body mass index (BMI) was 43 ± 22 years, 88 ± 14 kg and 31 ± 5 kg/m2, respectively. A two-compartment linear model adequately described the data. Median population pharmacokinetic parameter estimates were as follows: clearance in the presence of EDDf (CLEDDf), 6.41 L/h; clearance of EDDf (CLnon-EDDf), 4.97 L/h; volume of distribution of the central compartment (Vc), 56.46 L; intercompartmental clearance from the central to peripheral compartment (kCP), 13.54 L/h; and intercompartmental clearance from the peripheral to central compartment (kPC), 21.93 L/h. This is the first population pharmacokinetic model of ticarcillin in patients receiving EDDf. Large pharmacokinetic variability was found, supporting further investigation of the pharmacokinetics of less-studied ß-lactam antibiotics in prolonged intermittent renal replacement therapy.


Assuntos
Lesão Renal Aguda/terapia , Antibacterianos/farmacocinética , Estado Terminal , Hemofiltração/métodos , Ticarcilina/farmacocinética , Adulto , Idoso , Antibacterianos/administração & dosagem , Cromatografia Líquida , Feminino , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Plasma/química , Ticarcilina/administração & dosagem , Adulto Jovem
5.
Blood Purif ; 48(1): 18-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039563

RESUMO

BACKGROUND: Recent innovations in biomaterials technology have led to the development of innovative sorbents adopted as adsorbing devices in the field of extracorporeal blood purification therapies. As removal mechanism, adsorption allows to remove specific molecules, selectively binding them to sorbent materials. In addition to the material properties, a quintessential aspect influencing device properties is blood flow distribution within the sorbent particles. OBJECTIVES: In order to adequately characterize the potential adsorbing properties for an effective blood purification therapy, an in vitro study assessing the fluid dynamics inside 3 new cartridges, HA130, HA230 and HA330 (Jafron, Zhuhai City, -China) was conducted through CT imaging technique. -Methods: The cartridges were placed in vertical position in the CT -gantry. Dye solution was circulated through the cartridges at 250 mL/min, longitudinal sections, 0.5 cm thick, were recorded for 60 s. Furthermore, an in vitro test was conducted to build pressure drop profiles. Blood was circulated at a different flow rate, 100-400 mL/min, step 50 mL/min. Pre and post cartridges pressures were acquired and pressure drop calculated. RESULTS: Sequential images demonstrated an excellent distribution of the flow inside the cartridges. Average flow velocity was 0.37 cm/s for the 3 cartridges. HA130 had a homogeneous flow profile along the entire length of the device; HA230 and HA330 showed minimal differences between central and peripheral regions. Pressure drop profiles resulted linear, increasing proportionally with blood flow rate and packing density. CONCLUSIONS: We may conclude that the structural and functional design of the studied cartridges is adequate for haemoperfusion with no channelling phenomena. This ensures maximum and optimal utilization of the sorbent contained in the devices.


Assuntos
Circulação Extracorpórea , Hemofiltração , Hidrodinâmica , Tomografia Computadorizada por Raios X , Circulação Extracorpórea/instrumentação , Circulação Extracorpórea/métodos , Hemofiltração/instrumentação , Hemofiltração/métodos , Humanos , Tomografia Computadorizada por Raios X/métodos
6.
Blood Purif ; 48(3): 196-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039564

RESUMO

Extracorporeal blood purification techniques have emerged and evolved in the recent years as a potential therapy for the purpose of immunomodulation in acute conditions like sepsis. Understanding the extent of immune system dysregulation involved in the pathophysiology of these conditions, resulted in the development of such treatment strategies aiming at restoring a balanced inflammatory response. Beyond conventional continuous renal replacement therapy, high volume hemofiltration, high cut-off membranes, adsorption alone and coupled plasma filtration adsorption are well-described techniques in the literature. The evidence to support their routine use, however, is conflicting and insufficient at this stage. Despite the low-quality level of evidence in favor of utilizing these techniques, studies to further explore their effectiveness, safety, and potential novel applications, continue to evolve. Our review aims at focusing on adsorption therapy, particularly using the adsorption columns Cystosorb.


Assuntos
Adsorção , Circulação Extracorpórea/métodos , Imunomodulação , Hemofiltração/métodos , Humanos , Terapêutica
7.
Med Sci Monit ; 25: 3964-3975, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31134957

RESUMO

BACKGROUND Studies have been carried out to assess the efficacy of high-volume hemofiltration (HVHF) among critically ill patients. However, it is currently unclear whether HVHF is really valuable in critically ill patients. MATERIAL AND METHODS Randomized controlled trials evaluating HVHF for critically ill adult patients were included in this analysis. Three databases were searched up to July 27, 2018. The relative risk (RR), mean difference (MD), and 95% confidence intervals (CI) were determined. RESULTS Twenty-one randomized controlled trials were included in this analysis. Overall, HVHF was associated with lower mortality compared with control measures (RR=0.88, 95% CI=0.81 to 0.96, P=0.004) in critically ill patients. Sub-analysis revealed HVHF reduced mortality in sepsis and acute respiratory distress syndrome patients, but no similar effect in other diseases. HVHF decreased levels of plasma tumor necrosis factor and interleukin 6. The heart rate of the HVHF group after treatment was slower than the control group, while we found higher mean arterial pressure in the HVHF group, but oxygenation index was not significantly different between the two groups. HVHF had no remarkable influence on acute physiological and chronic health evaluation score (APACHE II score) compared with the control group. CONCLUSIONS HVHF might be superior to conventional therapy in critically ill patients.


Assuntos
Estado Terminal/mortalidade , Estado Terminal/terapia , Hemofiltração/efeitos adversos , APACHE , Adulto , Pressão Arterial , Feminino , Frequência Cardíaca/fisiologia , Hemofiltração/métodos , Humanos , Unidades de Terapia Intensiva , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/terapia , Sepse/terapia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
9.
Crit Care ; 23(1): 108, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30944029

RESUMO

BACKGROUND: Cardiopulmonary bypass (CPB) is often associated with degrees of complex inflammatory response mediated by various cytokines. This response can, in severe cases, lead to systemic hypotension and organ dysfunction. Cytokine removal might therefore improve outcomes of patients undergoing cardiac surgery. CytoSorb® (Cytosorbents, NJ, USA) is a recent device designed to remove cytokine from the blood using haemoadsorption (HA). This trial aims to evaluate the potential of CytoSorb® to decrease peri-operative cytokine levels in cardiac surgery. METHODS: We have conducted a single-centre pilot randomized controlled trial in 30 patients undergoing elective cardiac surgery and deemed at risk of complications. Patients were randomly allocated to either standard of care (n = 15) or CytoSorb® HA (n = 15) during cardiopulmonary bypass (CPB). Our primary outcome was the difference between the two groups in cytokines levels (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10, TNF-α, IFN-γ, MCP-1) measured at anaesthesia induction, at the end of CPB, as well as 6 and 24 h post-CPB initiation. In a consecutive subgroup of patients (10 in HA group, 11 in control group), we performed cross-adsorber as well as serial measurements of coagulation factors' activity (antithrombin, von Willebrand factor, factor II, V, VIII, IX, XI, and XII). RESULTS: Both groups were similar in terms of baseline and peri-operative characteristics. CytoSorb® HA during CPB was not associated with an increased incidence of adverse event. The procedure did not result in significant coagulation factors' adsorption but only some signs of coagulation activation. However, the intervention was associated neither with a decrease in pro- or anti-inflammatory cytokine levels nor with any improvement in relevant clinical outcomes. CONCLUSIONS: CytoSorb® HA during CPB was not associated with a decrease in pro- or anti-inflammatory cytokines nor with an improvement in relevant clinical outcomes. The procedure was feasible and safe. Further studies should evaluate the efficacy of CytoSorb® HA in other clinical contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT02775123 . Registered 17 May 2016.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Citocinas/efeitos adversos , Hemofiltração/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/métodos , Quimiocina CCL2/análise , Quimiocina CCL2/sangue , Citocinas/sangue , Citocinas/metabolismo , Feminino , Hemofiltração/métodos , Hemofiltração/normas , Humanos , Interleucina-10/análise , Interleucina-10/sangue , Interleucina-1alfa/análise , Interleucina-1alfa/sangue , Interleucina-1beta/análise , Interleucina-1beta/sangue , Interleucina-2/análise , Interleucina-2/sangue , Interleucina-4/análise , Interleucina-4/sangue , Interleucina-5/análise , Interleucina-5/sangue , Interleucina-6/análise , Interleucina-6/sangue , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangue
11.
Crit Care ; 23(1): 135, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014366

RESUMO

BACKGROUND: Veno-venous extracorporeal CO2 removal (vv-ECCO2R) and non-invasive neurally adjusted ventilator assist (NIV-NAVA) are two promising techniques which may prevent complications related to prolonged invasive mechanical ventilation in patients with acute exacerbation of COPD. METHODS: A physiological study of the electrical activity of the diaphragm (Edi) response was conducted with varying degrees of extracorporeal CO2 removal to control the respiratory drive in patients with severe acute exacerbation of COPD breathing on NIV-NAVA. RESULTS: Twenty COPD patients (SAPS II 37 ± 5.6, age 57 ± 9 years) treated with vv-ECCO2R and supported by NIV-NAVA were studied during stepwise weaning of vv-ECCO2R. Based on dyspnea, tolerance, and blood gases, weaning from vv-ECCO2R was successful in 12 and failed in eight patients. Respiratory drive (measured via the Edi) increased to 19 ± 10 µV vs. 56 ± 20 µV in the successful and unsuccessful weaning groups, respectively, resulting in all patients keeping their CO2 and pH values stable. Edi was the best predictor for vv-ECCO2R weaning failure (ROC analysis AUC 0.95), whereas respiratory rate, rapid shallow breathing index, and tidal volume had lower predictive values. Eventually, 19 patients were discharged home, while one patient died. Mortality at 90 days and 180 days was 15 and 25%, respectively. CONCLUSIONS: This study demonstrates for the first time the usefulness of the Edi signal to monitor and guide patients with severe acute exacerbation of COPD on vv-ECCO2R and NIV-NAVA. The Edi during vv-ECCO2R weaning was found to be the best predictor of tolerance to removing vv-ECCO2R.


Assuntos
Dióxido de Carbono/efeitos adversos , Hemofiltração/métodos , Suporte Ventilatório Interativo/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Análise de Variância , Gasometria/métodos , Dióxido de Carbono/metabolismo , Feminino , Hemofiltração/tendências , Humanos , Suporte Ventilatório Interativo/tendências , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Escala Psicológica Aguda Simplificada
12.
Blood Purif ; 47 Suppl 3: 1-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30974444

RESUMO

Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club "Cappuccino with Claudio Ronco" at  https://www.karger.com/Journal/ArticleNews/223997?sponsor=52.


Assuntos
Hemofiltração/métodos , Sepse/sangue , Sepse/terapia , Citocinas/sangue , Endotoxinas/sangue , Hemofiltração/instrumentação , Humanos
13.
Blood Purif ; 47 Suppl 3: 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30982026

RESUMO

BACKGROUND: oXiris is a blood purification product that has been launched recently in China. In addition to renal function support and fluid management capabilities, it can also adsorb cytokines and endotoxins. This may complement standard treatment for septic acute kidney injury (AKI) patients to control the amplitude of systemic inflammatory response responsible for acute tissue and organ damage. Objectives of our study are to elucidate characteristics of septic AKI patients who respond to treatment with oXiris and to describe the performance of oXiris through patient cases in the absence of large randomized trials on clinical use of oXiris for septic AKI patients in China. SUMMARY: Here, we present 4 cases managed in intensive care units of major hospitals in China. Key practical aspects from an expert meeting discussing these cases have been included as guidance for the use of oXiris in septic AKI patients. Key Messages: Based on the experience gathered from 4 cases, oXiris should be used early in the treatment of septic AKI patients as an adjuvant therapy with good infection source control. It should not be used to delay or replace infection source control. These cases also demonstrated that patients with high risk of bleeding can use oXiris without additional anticoagulation for up to 36 h without implications on serum protein levels and platelet count. Short of definitive biomarkers to gauge the ideal blood purification initiation and discontinuation time for septic AKI patients, clinical judgment is key to determining optimal use of oXiris in septic AKI patients.


Assuntos
Lesão Renal Aguda/terapia , Hemofiltração/instrumentação , Sepse/terapia , Lesão Renal Aguda/sangue , Adulto , Idoso , Biomarcadores/sangue , Cuidados Críticos/métodos , Hemofiltração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/sangue
14.
Blood Purif ; 47 Suppl 3: 1-3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30982027

RESUMO

BACKGROUND: Lipopolysaccharide (endotoxin) from the outer Gram-negative bacterial wall can induce a harmful immunologic response, involving hemodynamic deprivation, and is one important motor driving the septic cascade. The positively charged poly-imine ethylene layer on the oXiris membrane is capable of adsorbing negatively charged endotoxin molecules and removing them from the blood compartment. Endotoxin is detrimental and should be removed from blood. SUMMARY: The adsorbable endotoxin fraction in blood arises from a tight balance between seeding from an infectious focus and removal by an overwhelmed immune system. The net sum of remaining endotoxin in blood is available for an adsorption process in the oXiris filter. Endotoxin data from 2 patients with severe Gram-negative septic shock and endotoxemia in this case series, speaks for a considerable share of the adsorption of the oXiris filter in the endotoxin net removal over time. Key Messages: Analysis of combined in vitro and in vivo data speaks for an effect of the oXiris filter in lowering endotoxin.


Assuntos
Endotoxinas/sangue , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/terapia , Hemofiltração , Choque Séptico/sangue , Choque Séptico/terapia , Idoso , Idoso de 80 Anos ou mais , Hemofiltração/instrumentação , Hemofiltração/métodos , Humanos , Masculino , Suécia
15.
Blood Purif ; 47 Suppl 3: 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30982028

RESUMO

BACKGROUND: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). SUMMARY: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74-87] SAPS II quartile and 70 vs. 98% for the [87-163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52-2.45] µg/kg/min; at 48 h it was 0.20 [0.09-1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.


Assuntos
Infecções por Bactérias Gram-Negativas , Hemofiltração , Mortalidade Hospitalar , Insuficiência de Múltiplos Órgãos , Choque Séptico , Idoso , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Negativas/terapia , Hemofiltração/instrumentação , Hemofiltração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/terapia , Estudos Retrospectivos , Choque Séptico/sangue , Choque Séptico/mortalidade , Choque Séptico/terapia
16.
Blood Purif ; 47 Suppl 3: 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30982031

RESUMO

BACKGROUND: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. METHOD: A modified Delphi-based method was used to collate -European experts' views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. RESULTS: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. CONCLUSION: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required.


Assuntos
Lesão Renal Aguda/terapia , Hemofiltração/instrumentação , Membranas Artificiais , Sepse/terapia , Europa (Continente) , Feminino , Hemofiltração/métodos , Humanos , Masculino , Guias de Prática Clínica como Assunto
17.
Chin Med J (Engl) ; 132(10): 1208-1211, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30882465

RESUMO

BACKGROUND: Blood purification (BP) is one of the most important rescue measures for patients with critical illness in the intensive care unit (ICU), especially for those with acute kidney injury. The purpose of this nationwide survey was to reveal the real world of current BP practice in different ICUs all over China. This study was designed to be a multi-center cross-sectional study. METHODS: All adult patients (over 18 years of age), who were admitted to ICU and required BP in 35 sub-centers across China were included during 30-day survey period in 2018. Demographic characteristics and clinical data were recorded including the timing of treatment initiation, indications, modality, relative contraindication, establishment of vascular access, selection of filter/membrane, settings, anti-coagulation, executive department, complication, intake, and output. DISCUSSION: This nationwide survey may contribute to reveal the real world of current BP practice in different ICUs all over China. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-EOC-17013119; http://www.chictr.org.cn/showproj.aspx?proj=22487.


Assuntos
Hemofiltração/métodos , China , Estudos Transversais , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Teóricos
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(2): 214-220, 2019 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-30827312

RESUMO

OBJECTIVE: To systematically analyze the effect of haemoperfusion (HP) combined with continuous veno-veno haemofiltration (CVVH) in the treatment of the patients with paraquat poisoning (PQP). METHODS: Words of paraquat, poisoning, continuous venous hemofiltration, hemoperfusion, hemodiafiltration in Chinese and paraquat, poisoning, intoxication, haemofiltration, continuous venovenous haemofiltration, haemoperfusion in English were chosen as keywords, the Chinese and English literatures about acute PQP treated with HP combined with CVVH published in Wanfang database, CNKI, CBM, VIP database, PubMed, Embase, Cochrane Library were searched by computer, and the retrieval time was from the establishment of the database to July 2018. The experimental group was treated with HP combined with CVVH, while the control group was treated with HP alone. Besides, the outcome indicators included mortality, survival time of dead patients (the patient's time from exposure to poison to death), serum creatinine (SCr), alanine aminotransferase (ALT), arterial partial pressure of oxygen (PaO2), and incidence of circulatory and respiratory failure. The literature data were extracted by two researchers independently, the quality of the literature was evaluated according to the modified Jadad score table or Newcastle-Ottawa scale (NOS), and the Meta-analysis was carried out by RevMan 5.3 software; and the stability of the results of Meta-analysis was tested by sensitivity analysis. Further, the publication bias was analyzed through drawing a funnel diagram. RESULTS: Finally, 20 articles were included, with 18 in Chinese and 2 in English. Among them, 6 were randomized controlled trial (RCT) and 14 were case-control studies. Furthermore, a total of 2 870 patients were involved, with 1 558 in the control group and 1 312 in the experimental group. Meta-analysis showed that the mortality rate of patients in the experimental group was significantly lower than that in the control group [odds ratio (OR) = 0.55, 95% confidence interval (95%CI) = 0.42 to 0.73, P < 0.000 1], the patients' time from toxin exposure to death was significantly longer than that in the control group [standard mean difference (SMD) = 2.16, 95%CI = 1.46 to 2.86, P < 0.000 01). In the course of treatment, the peak value of SCr in the experimental group was significantly lower than that in the control group (SMD = -0.53, 95%CI = -0.65 to -0.42, P < 0.000 01), and the peak value of ALT was also decreased (SMD = -0.72, 95%CI = -0.99 to -0.44, P < 0.000 01). Besides, there was no significant difference in PaO2 between the two groups on the 3rd day of treatment (SMD = 0.15, 95%CI = -0.19-0.49, P = 0.40), but on the 7th day, PaO2 in the experimental group was significantly higher than that in the control group (SMD = 0.23, 95%CI = 0.29 to 0.98, P = 0.000 3). Furthermore, the incidence of circulatory failure in the experimental group was significantly lower than that in the control group (OR = 0.26, 95%CI = 0.19 to 0.37, P < 0.000 01), but the incidence of respiratory failure was significantly higher than that in the control group (OR = 4.14, 95%CI = 3.00 to 5.72, P < 0.000 01). The influence of heterogeneity on statistical results was excluded in the sensitivity analysis, and funnel plot diagram was applied to indicate the publication bias of mortality and survival time of the dead patients. CONCLUSIONS: Combined with HP alone, HP combined with CVVH could better improve liver and kidney function and oxygenation state of PQP patients, reduce the incidence of early circulatory failure, prolong the survival time and reduce the death rate of PQP patients.


Assuntos
Hemofiltração/métodos , Hemoperfusão/métodos , Paraquat/envenenamento , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(12): e14873, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896634

RESUMO

BACKGROUND: The incidence of acute pancreatitis (AP) is rising around the world, thus further increasing the burden on healthcare services. Approximately 20% of AP will develop severe acute pancreatitis (SAP) with persistent organ failure (>48 h), which is the leading cause of high mortality. To date, there is no specific drug in treating SAP, and the main treatment is still based on supportive care. However, some clinical control studies regarding the superiority of continuous blood purification (CBP) has been published recently. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CBP in SAP treatment. METHODS: Four databases (Medline, SinoMed, EMBASE, and Cochrane Library) were searched for eligible studies from 1980 to 2018 containing a total of 4 randomized controlled trials and 8 prospective studies. RESULTS: After the analysis of data amenable to polling, significant advantages were found in favor of the CBP approach in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score (WMD = -3.00,95%CI = -4.65 to -1.35), serum amylase (WMD = -237.14, 95% CI = -292.77 to 181.31), serum creatinine (WMD = -80.54,95%CI = 160.17 to -0.92), length of stay in the ICU (WMD = -7.15,95%CI = -9.88 to -4.43), and mortality (OR = 0.60, 95%CI = 0.38-0.94). No marked differences were found in terms of C-reactive protein (CRP), alamine aminotransferase (ALT) and length of hospital stay (LOS). CONCLUSION: Compared with conventional treatment, CBP remedy evidently improved clinical outcomes, including reduced incidence organ failure, decreased serum amylase, APACHE II score, length of stay in the ICU and lower mortality rate, leading us to conclude that it is a safer treatment option for SAP. Furthermore, relevant multicenter RCTs are required to prove these findings.


Assuntos
Hemofiltração/métodos , Insuficiência de Múltiplos Órgãos/etiologia , Pancreatite/complicações , Pancreatite/terapia , APACHE , Doença Aguda , Humanos , Mediadores da Inflamação/metabolismo , Tempo de Internação , Insuficiência de Múltiplos Órgãos/prevenção & controle , Pancreatite/fisiopatologia , Estudos Prospectivos
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