1. Regional citrate anticoagulation in critically Ill patients treated with plasma filtration and adsorption
- Author
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Antonio Miletto, Piera Biolino, Ciro Tetta, Giorgio Triolo, Filippo Mariano, and Maurizio Stella
- Subjects
Male ,medicine.medical_treatment ,Regional citrate anticoagulation ,Acute renal failure ,Septic shock ,Dialysis Solutions ,Cancer ,Acute kidney injury ,Shock ,General Medicine ,Hematology ,Acute Kidney Injury ,Middle Aged ,Shock, Septic ,Plasmafi ltration ,Sorbent technology ,Adult ,Aged ,Anticoagulants ,Burns ,Calcium ,Chemotherapy, Cancer, Regional Perfusion ,Citric Acid ,Contraindications ,Critical Illness ,Female ,Hemorrhage ,Heparin ,Humans ,Multiple Trauma ,Sorption Detoxification ,Treatment Outcome ,Hemofiltration ,Nephrology ,Anesthesia ,Shock (circulatory) ,Hemodialysis ,medicine.symptom ,medicine.medical_specialty ,medicine ,Chemotherapy ,Renal replacement therapy ,Contraindication ,Calcium metabolism ,business.industry ,Regional Perfusion ,Septic ,medicine.disease ,Surgery ,business - Abstract
Background: In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA). Methods: Thirteen critically ill patients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions). Results: Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionized calcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present. Conclusions: These results demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.
- Published
- 2004