OPIOID FREE GENERAL ANESTHESIA IN CLINICAL PRACTICE - A REVIEW ARTICLE.

Currently, enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways with the goal to achieve early patient recovery after surgery with minimal postoperative complications. According to studies, opioid free general anesthesia has many perioperative benefits and should be part of the ERAS protocols in specific surgical and patient indications. Opioid free general anesthesia is a multimodal balanced technique that is based on the concept that opioids are not used preoperatively or intraoperatively until the patient has aroused. The basic concept of opioid free general anesthesia is intravenous administration of several nonopioid drugs that operate at different pharmacological sites blocking surgical stress and sympathetic activation response. Moreover, current studies have shown that opioid free anesthesia is a technique which satisfactorily controls postoperative pain as the fifth vital sign, and has minimal side effects and better patient recovery with the same surgical conditions as general multimodal balanced anesthesia. However, further research is needed.

Pollution and Health Risk Assessments of Potentially Toxic Elements in Soil and Sediment Samples in a Petrochemical Industry and Surrounding Area.

The pollution state and health risk assessment of potentially toxic elements (PTE) in soil and sediment samples of the petrochemical industry and its surrounding area are evaluated in this study. The pseudo-total contents of Ba, Cd, Co, Cu, Cr, Mn, Ni, Pb, V, Zn, As, Hg, and Se were measured by inductively coupled plasma-optical emission spectrometry (ICP/OES) in analyzed samples. Instead of determining total content, we performed aqua regia of the samples. The silicate matrix remained, and the quantities of elements that are within the silicate matrix do not represent an environmental danger. The soils from the chlor-alkali plant are highly polluted by Hg (the enrichment factor values were above 6000), and by Cu, Cd, Pb, and Zn, while the sediment samples from the wastewater channel are polluted with Cr, Cd, and Hg. The measured element contents are used for calculating health risk criteria for a composite worker (a worker who is exposed, long-term, during the work day) and for residential people. Hg is the element that mainly contributes to non-carcinogenic risks within the petrochemical area. The highest value of total carcinogenic risk obtained in the sediment sample from the wastewater channel, and the metal that mostly contributes is Cr. The areas closest to the petrochemical industry have higher values of health risk criteria parameters and pollution indices. The areas that are located further to the north and south from the petrochemical industry are less burdened with the analyzed elements, which is significant because the closest city and village are situated in those directions.

Geochemical Fractionation and Assessment of Probabilistic Ecological Risk of Potential Toxic Elements in Sediments Using Monte Carlo Simulations.

The need for further research into potentially toxic elements in Serbian rivers led to an investigation of distributions, sources, and ecological risks in a sample base of sediments from 15 rivers. The analyses were carried out through both experimental and theoretical methods. Geochemical fractionation of Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, As, V, and Zn in sediments was studied using a sequential extraction procedure. Both a Håkanson risk index (RI) and a Monte Carlo simulation (MCS) were used in order to estimate ecological risk, applying the probability distribution of RI values instead of single-point calculations. In order to both further the development of the used method and include additional processes, software for the simulations was developed instead of using proprietary solutions. Metal fractionation showed high percentage recoveries of Cd, Cr, Co, Cu, Fe, Ni, and V in residual fractions. The high content of Pb, Mn, and Zn in mobile fractions might cause serious environmental concerns. In some localities, Cu and Cd could be problematic elements, since their mobility was high. An environmental assessment based on the described criteria provided risk levels varying from low to median (mainly contributed by Cd and Cu).

Natural and anthropogenic sources of chromium, nickel and cobalt in soils impacted by agricultural and industrial activity (Vojvodina, Serbia).

This study reports the contents and sources of chromium, nickel and cobalt, as well as Al, Ca, Mg, K, Fe and Mn in Vojvodina regions Srem and Central Banat area soil samples. Different methods were applied to identify the sources of the studied elements and to classify the latter as geogenic and/or anthropogenic: modified Tessier sequential extraction, calculation ratio of E/Al, XRPD, correlations and cluster analysis. The sampling methodology was according to the GEMAS project. The results show that increasing content of chromium, cobalt and nickel detected in studied soils can be explained by a distribution pattern and the presence of ultramafic and mafic parent rocks, as well as by significant anthropogenic pollution, mainly originating from the industry at some localities. The statistically significant difference between the content of Cr and Ni in soils of Srem and C. Banat is observed. The content of the studied elements is higher in soils of Srem. The normalization to Al indicating a presence of the anthropogenic sources which my significantly affect the content of Cr and Ni in the soils from Beocin, Ruma and Stara Pazova. There is no shown influence of eventual agrochemicals application on the Cr, Ni and Co content.

Environmental impact of industrial and agricultural activities to the trace element content in soil of Srem (Serbia).

This study reports the contents and sources of Cu, Hg, Cr, Ni, Co, Zn, Pb, Cd, As, and B pollution in soil samples from Srem in the province of Vojvodina (Republic of Serbia). They are collected in the vicinity of local industrial facilities. The main objective of this study is evaluating the impact of the industrial facilities on the eventual contamination of soils used mostly for agricultural manufacturing. This paper describes the implementation of the combination of methods to estimate the ecological status and determine potential ecological risk. This study applies sequential extraction, pollution indices, comparison with the guidelines, and statistical analysis. Other soil parameters, such as organic matter content, pH, and clay content were measured to evaluate their influence on the trace element content. The investigated soil samples exhibited the raised contents of Ni, Hg, and Cu. Elevated contents of toxic elements observed in localities accommodated within an impact zone affected by industrial complexes, indicating a correlation between the contamination of surrounding soil and potential impact on plants. The most mobile elements are Hg, Cd, and B, while Cr is the least mobile and potential least bioavailable. The results indicate Cr and Ni content increase marking the presence of bedrock, notably in the area of underlying ultramafic rocks and the surface zones influenced by diluvial-proluvial and alluvial processes. The second source of Cr and Ni in the soils of Srem is industrial activities such as leather, cement industry, as well as the metal processing factory.

Fractionation, Mobility, and Contamination Assessment of Potentially Toxic Metals in Urban Soils in Four Industrial Serbian Cities.

The main soil properties, concentrations of selected elements (As, Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn), and the chemical speciation of each element were determined in urban soil samples taken from urban parks in four Serbian cities (Belgrade, Pancevo, Obrenovac, and Smederevo) exposed to different sources of pollution. Pollution indices (PI, PIN) and factors (MF, ICF, GCF) also were evaluated. The study revealed As and Cd concentrations below the detection limit, whereas the content of Cr, Cu, Fe, Mn, Ni, Pb, and Zn at some sites exceeded the limits established by local regulations, as well as the background values, which may represent an environmental threat. Sequential extraction results show that Fe, Cr, Cu, and Ni were predominantly in the residual fraction at most sites; however, Ni from Pancevo and Smederevo also was bound to the reducible fraction. The presence of Pb at all sites and Zn in Smederevo and Belgrade was mainly associated with the reducible and residual fractions. The highest Mn content was found in the reducible fraction, followed by the acid soluble/exchangeable and residual fractions. Based on the obtained indices and factors, the overall soil status at the selected sampling sites was found to range from the warning limit to slightly polluted, whereby Smederevo had the highest risk, and Pancevo and the control site the lowest risk of contamination by toxic metals.

Assessment of contamination, environmental risk, and origin of heavy metals in soils surrounding industrial facilities in Vojvodina, Serbia.

Content of potentially toxic elements was examined in soils from Srem (Vojvodina), to evaluate industrial facilities as pollution sources. Based on the distribution of the elements, the results of sequential extraction, enrichment factor (EF), ecological risk factor (Er), ecological risk index (RI), and statistical analysis, the current ecological status of the soils was determined. Elements in soils around the industrial facilities can be grouped into the five significant components derived by the principal component analysis (PCA), which explains 78.435% of the total variance. Al, Fe and Mg, and K and Mn are associated with two lithogenic components, respectively. Anthropogenic origin is identified for Hg and Cd. Mixed sources, geogenic and anthropogenic, are identified within two PCA components; one wich includes As, Pb, B, Zn, and the other: K and Cr, Ni and Cu. Cluster analysis (CA) corroborated the results obtained by PCA. The preliminary results revealed that the soils studied in a vicinity of industrial facilities in Srem have been exposed to different degrees of pollution. Among the characterized studied elements, Pb, Cd, Hg, Cu, Ni, and Cr are the main contaminants. Based on calculated EF, the studied soils show minor to severe enrichment with heavy metals. Ecological risk assessment results indicate that Cd and Hg carry the highest ecological risk level, and Zn and Cr the lowest.

Postoperative Atrial Fibrillation Prophylaxis and Lung Resection ­ Our Experience with 608 Consecutive Patients

Postoperative atrial fibrillation is a common complication after lung resection. It is burdened by increased mortality and morbidity, prolonged hospitalization, and higher resource utilization in thoracic surgery patients. Therefore, some kind of pharmacological prophylaxis is recommended. In our patients, diltiazem, a calcium antagonist, is administered. We collected data on all 608 patients having undergone lung resection (no less than lobectomy) between November 2012 and May 2015. This period included patients having received diltiazem during their postoperative stay in our Intensive Care Unit and surgical ward, and those that did not receive it. Patients having had atrial fibrillation before the surgery and patients with cardiac pacemaker were excluded from the trial. Other patients were divided into three groups: patients with some kind of antiarrhythmic therapy before and continued after the surgery; patients with diltiazem prophylaxis; and patients without any antiarrhythmic prophylaxis. The data collected were statistically analyzed. We found no statistically significant difference in the incidence of postoperative atrial fibrillation among the groups (p<0.05).

Aquatic sediments pollution estimate using the metal fractionation, secondary phase enrichment factor calculation, and used statistical methods.

The sequential extraction procedure of the European Community Bureau of Reference (BCR) was applied for the fractionation of Cd, Cr, Cu, Ni, Pb, Zn, Fe, Mn, and V in the Serbian river sediments. The aim of this paper was to describe a new approach in detection of anthropogenic elements in sediments, related to the Serbian river courses in order to assess their metal contamination. For sediment pollution evaluation, the risk assessment code (RAC) and the secondary phase enrichment factor (KSPEF) were used. Metal fractionation showed more easily mobilized forms predominant for copper, zinc, cadmium, manganese, and lead, which can be one of the indicators for anthropogenic source input. Chromium, nickel, iron, and vanadium found in the residual fraction indicate these metals may be an indicator for natural sources input. Based on RAC classification, results of sediments show no risk (Cr and V), low risk (Ni, Pb, and Fe), medium risk (Cu), high risk (Cd and Zn), and very high risk (Mn). The mean values of KSPEF were Cd > Cu > Zn > Ni > Mn > Pb > Fe > Cr > V, decreasing scale of no to moderately severe enrichment. The sediments were found to be contaminated by heavy metals to various extents, mostly Cd, Cu, and Zn. Research has shown the importance of KSPEF in quantifying degree of metal enrichment in sediments using results of sequential extraction. With the application of this factor, which is not frequently used in the scientific literature, the results obtained with sequential extraction can be used not only for assessment of mobility but also to quantify the metal pollution.

Effect of Inhalational Anesthetics on Acute Kidney Injury

Acute kidney injury (AKI) is a serious complication associated with increased morbidity and mortality. Total incidence of AKI in hospitalized patients is 1%-5%. As many as 30% of these patients develop AKI in the perioperative period, which is associated with anesthesia and surgery. Despite scientific advances and improved surgery techniques, as well as treatment in intensive care units, no significant decrease in AKI incidence has been achieved. To change this outcome, it is important to identify patients at risk of AKI and prevent its occurrence. Correct selection of anesthetic drugs during general anesthesia, adjusted to the individual needs of patients, also influences the overall outcome of treatment. Nowadays, inhalational anesthetics are not considered nephrotoxic. The more so, inhalational anesthetics have a strong and direct protective effect on many organs through preconditioning and postconditioning. New studies have shown that sevoflurane diminishes ischemia/ reperfusion kidney injury and has an anti-inflammatory effect, thus having the potential to reduce the occurrence of AKI. Given the incidence of AKI in the perioperative period, as well as new findings about anesthetics, the issue of anesthetic selection during general anesthesia might be of crucial importance for the final outcome of treatment.

Evaluation of sediment contamination with heavy metals: the importance of determining appropriate background content and suitable element for normalization.

In the present study, concentrations of heavy metals (Cd, Cu, Co, Mn, Cr, Ni, Pb, and Zn) were determined at 35 river sediments in Serbia. The anthropogenic heavy metals input and quantification of the metal enrichment degree in sediments were estimated by calculating geo-accumulation indices (I(geo)) and enrichment factors (EF). These pollution indices have been calculated using different background values (continental crust and local background values) and different element used for normalization (Al and Fe), followed by result comparison. The EF values calculated with continental crust as background (minor to extremely severe enrichment) were higher than when regional background values were used (minor to moderate enrichment). Significant influence of background values on the I(geo) values is observed. Values of geo-accumulation index (<2) revealed that studied river sediments are remaining unpolluted to moderately polluted with Co, Mn, Cr, and Ni. Significant pollution in the sediments was observed for Cd, Cu, Pb, and Zn elements. The results of this study confirm the relevance of precise and accurate determining of local background concentrations while assessing sediment pollution. The values of EFs for studied elements were more influenced by the choice of background values than selection of element used for normalization. Our recommendation would be to use the local and regional background content in quantification of metal contamination in sediments, since these values differ and are site and region dependent.

Freshwater environmental quality parameters of man-made lakes of Serbia.

In this study, 28 lakes were selected from the freshwater resources of the network of man-made lakes throughout the Vojvodina Province and the central part of Serbia. Samples were analyzed for the physicochemicals indicators of the water and nutrients. Most of the values of the chemicals indicators and nutrients of the samples from the Vojvodina Province exceeded the Water Act and Regulations on the Monitoring of Water Quality introduced by the Government of the Republic of Serbia (MWQ) and/or the World Health Organization (WHO) drinking water standards. These samples may not be suitable for human consumption. The sample from Lake Meduvrsje, where the NH4 (+) concentration was 0.28 mg/L, and the sample from Ovcar Banja, where the total phosphorus (TP) content was 0.15 mg/L with a high total nitrogen (TN) content of 1.21 mg/L, are particularly noteworthy. These high concentrations exceeded the proposed guidelines for safe drinking water; therefore, water from these lakes should be used with care as harmful health effects may occur. The majority of the Serbian lakes are characterized by phosphorus-limited photosynthesis.

The influence of exploration activities of a potential lithium mine to the environment in Western Serbia.

The proposed exploitation of the Jadar Valley lithium/borate deposit in Serbia, by the Rio Tinto Corporation, indicates that it would become large-scale processing of boron- and lithium-containing ore. It would be one of the world's very first lithium mines in populated and agricultural area. The company claims that the envisioned mining will be in accordance with environmental protection requirements. The Jadar Valley deposits have been claimed to cover 90% of Europe's current lithium needs. Yet, local opposition to the mining has arisen due to potential devastating impacts on groundwater, soil, water usage, biodiversity loss, and waste accumulation. Research drilling by the mining company has already produced environmental damage, with mine water containing high levels of boron leaking from exploratory wells and causing crops to dry out. Furthermore, our investigations reveal substantially elevated downstream concentrations of boron, arsenic, and lithium in nearby rivers as compared to upstream regions. Additionally, here we show that soil samples exhibit repeated breaches of remediation limit values with environmental consequences on both surface and underground waters. With the opening of the mine, problems will be multiplied by the tailings pond, mine wastewater, noise, air pollution, and light pollution, endangering the lives of numerous local communities and destroying their freshwater sources, agricultural land, livestock, and assets.

Potentially toxic elements in sediments near mines-a comprehensive approach for the assessment of pollution status and associated risk for the surface water environment.

This research is focused on the assessment of the pollution status of river and lake sediments near Pb, Zn, and Cu mines and tailings in the southeastern part of Serbia-Krajiste area. The study is based on hypothesis that investigated rivers and lakes in the Krajiste area could be polluted by potentially toxic elements (PTEs) and that these elements could pose considerable ecological risk to the studied surface water environment. High PTE contents are detected in studied river sediments (up to 7892 mg kg-1 for Zn, 3224 mg kg-1 for Cu, 36,790 mg kg-1 for Pb, 64.2 mg kg-1 for Cd, and 1444 mg kg-1 for As). Given that the contents of the studied elements in most of the river sediments exceeded the background values, values prescribed by regulations of the Republic of Serbia, as well as probable effect concentration (PEL), it is possible to conclude that sediments were heavily polluted and that detrimental effects can be expected. Contamination indices including the enrichment factor (EF), contamination factor (CF), index of geoaccumulation (Igeo), potential ecological risk index (Eri), ecological risk index (RI), pollution load index (PLI), and aggregative toxicity index (ATI) were used to assess the degree of pollution by PTEs. The ecological risk assessment revealed that there is a significant risk observed for toxic elements (primarily Pb, Cu, Cd, and As) at this moment. The highest contamination indices (EF, Igeo, CF, PLI, and ATI) are mainly associated with historical and current mining activities. The Monte Carlo analysis based on the risk assessment indices was used to evaluate the uncertainty. The most pronounced toxic risk is found for the Pb, Cu, Cd, and As which assessment was in the range of high and extremely high-risk probabilities. The obtained results suggest that levels of toxic elements pose a significant ecological risk to the surface water environment near Pb, Zn, and Cu mines in the Krajiste area. The methodology applied in this paper could be very useful for other researchers dealing with the problem of environmental pollution by toxic elements.

Conventional, microwave, and ultrasound sequential extractions for the fractionation of metals in sediments within the Petrochemical Industry, Serbia.

In this paper, the main objective was fractionation of Cd, Cu, Ni, Pb, Zn, Ca, Fe, and K in certificate material and sediment samples gathered from and around the Petrochemical Industry using the conventional, microwave and ultrasonic sequential extraction. Microwave oven and ultrasound bath were used as an energy source for achieving faster extraction. Additional heating and boiling of samples were avoided by using lower power and shorter time for microwave and ultrasound extraction. Precision and accuracy of procedure were evaluated by using certificate material (BCR701). Acceptable accuracy of metals (87.0-111.3 %) was achieved for all three-step sequential of conventional extraction protocol. An accuracy of the fourth step has been verified with two certificate materials: BCR143R and 146R. The range of total extracted metal concentrations from sediments was similar for all three extraction techniques. A significant high percentage of Cd, Cu, and Zn were obtained after extraction of the exchangeable and acid soluble sediment fraction. Principal component analysis of values obtained after determination of risk assessment code using conventional and ultrasound sequential extraction show similarity of these values. Accuracy, recovery, and risk assessment code values imply that ultrasound sequential extraction is a more suitable, accelerated sequential extraction procedure (30 min per extraction step) than microwave extraction in applied conditions.

The significance of applying different factors for the evaluation of sediment contamination by toxic elements and estimation of the ecological risk.

The optimized three-step sequential extraction procedure for the fractionation of micro- and macroelements, was conducted to determine fractional characteristics of PTEs (potentially toxic elements) in surface sediments of rivers in the Vlasina watershed. The sequential extraction results, which enable the evaluation of mobility of the studied elements, have indicated that Zn, Ni, Cu, Cr, and As can be considered slightly mobile, whereas Pb, Mn, Cd, and Co were regarded as possibly mobile elements. Lead was dominantly bounded (specifically adsorbed or co-precipitated) to iron and manganese oxides (up to 80%) and may be released by reduction. Since the content of the exchangeable fraction (F1) is an indicator for anthropogenic impact on the aquatic environment, a low percentage (0-8%) of studied toxic elements in this fraction indicated that these elements have lithogenic origin in most sampling locations in the area of study. Except for Pb, the substantial positive correlations between Al and other elements showed that studied elements came primarily from terrigenous sources. Although the values obtained for the risk assessment code (RAC) indicated a slightly increased mobility of some elements (up to 22.44%), the values of the modified risk assessment code (mRAC), which include toxic effects on the environment, showed there is no danger of pollution by studied elements (all values were < 1%). Our recommendation is to use mRAC instead of RAC in ecochemical studies and assessment of the degree of sediment and soil pollution, because mRAC includes toxic effects of elements. Based on ATI values, river sediments show no toxic to a low toxic degree. Even though obtained results indicate that there was no considerable risk for river water contamination, the ecological risk for Fe and Pb should be monitored in the future.

Healthcare-Associated Bloodstream Infections Due to Multidrug-Resistant Acinetobacter baumannii in COVID-19 Intensive Care Unit: A Single-Center Retrospective Study.

Healthcare-associated infections are an emerging cause of morbidity and mortality in COVID-19 intensive care units (ICUs) worldwide, especially those caused by multidrug-resistant (MDR) pathogens. The objectives of this study were to assess the incidence of bloodstream infections (BSIs) among critically ill COVID-19 patients and to analyze the characteristics of healthcare-associated BSIs due to MDR Acinetobacter baumannii in an COVID-19 ICU. A single-center retrospective study was conducted at a tertiary hospital during a 5-month period. The detection of carbapenemase genes was performed by PCR and genetic relatedness by pulsed-field gel electrophoresis (PFGE) and multilocus-sequence typing. A total of 193 episodes were registered in 176 COVID-19 ICU patients, with an incidence of 25/1000 patient-days at risk. A. baumannii was the most common etiological agent (40.3%), with a resistance to carbapenems of 100%. The blaOXA-23 gene was detected in ST2 isolates while the blaOXA-24 was ST636-specific. PFGE revealed a homogeneous genetic background of the isolates. The clonal spread of OXA-23-positive A. baumannii is responsible for the high prevalence of MDR A. baumannii BSIs in our COVID-19 ICU. Further surveillance of resistance trends and mechanisms is needed along with changes in behavior to improve the implementation of infection control and the rational use of antibiotics.

Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia.

Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas exchange can be treated with veno-venous ECMO, eliminating the need for aggressive mechanical ventilation which might promote ventilator-induced lung injury and increase mortality. In this retrospective observational study, 18 critically ill COVID-19 patients who were treated using V-V ECMO during an 11-month period in a tertiary COVID-19 hospital were analyzed. Biomarkers of inflammation and clinical features were compared between survivors and non-survivors. Survival rates were compared between patients receiving ECMO and propensity matched mechanically ventilated controls. There were 7 survivors and 11 non-survivors. The survivors were significantly younger, with a higher proportion of females, higher serum procalcitonin at ICU admission, and before initiation of ECMO they had significantly lower Murray scores, PaCO2, WBC counts, serum ferritin levels, and higher glomerular filtration rates. No significant difference in mortality was found between patients treated with ECMO compared to patients treated using conventional lung protective ventilation. Hypercapnia, leukocytosis, reduced glomerular filtration rate, and increased serum ferritin levels prior to initiation of V-V ECMO in patients with severe COVID-19 pneumonia may be early warning signs of reduced chance of survival. Further multicentric studies are needed to confirm these findings.

Assessment of arsenic and mercury contamination in the Tisa River sediments and industrial canal sediments (Danube alluvial formation), Serbia.

The purpose of this study was to examine the levels of As and Hg and mobility of these contaminants in the sediments of the River Tisa and canal sediments (alluvial formation of the Danube River, Serbia), in order to determine the degree to which the ecosystem is harmed by these pollutants. The sequential extraction procedure (modified Tessier method) was used to extract the metals from the sediments. Arsenic is extracted in the second, third and fifth fraction, with dominant extraction in the second fraction. This distribution indicates that As is significantly present in the form of carbonates, whereas the part of As is present in the form of oxides. The most important extraction of Hg is in the fifth stage (extraction with 6M HCl), with over 80 % of extracted element in both types of sediment, indicating a strong association between Hg and Fe crystalline oxides as well as presence of Hg in the form of sulfides. Based on arsenic and mercury content in sediments and results of sequential extraction it can be concluded that on the studied localities there is no significant As and Hg contamination.

[Renal replacement therapy in a polytraumatized patient with hemophilia]. / Nadomjestanje bubrezne funkcije u politraumatiziranog bolesnika s hemofilijom A.

Renal failure is a rare complication of hereditary coagulopathies. However, when it occurs, it rapidly progresses to a stage that requires replacement of renal function. Major problems include the choice of dialysis method, prevention of complications and supplementation of deficient factor. In hemodialysis, it is challenging to prevent system clotting and avoid bleeding. We present a case of polytraumatized male patient with hemophilia A, who developed compartment syndrome with acute renal failure. Continuous venovenous hemodialysis (CWHD) improved his condition and he recovered his kidney function. However, over the next few days he developed severe sepsis with deterioration of renal function. CWHDF (hemodiafiltration) was restarted. Several large hematomas were found in the abdominal cavity and in the inguinal region, one of them inducing compartment syndrome with leg necrosis. The patient died from cardiorespiratory arrest.