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Anticoagulation strategies in venovenous hemodialysis in critically ill patients: a five-year evaluation in a surgical intensive care unit.
- Source :
-
TheScientificWorldJournal [ScientificWorldJournal] 2014; Vol. 2014, pp. 808320. Date of Electronic Publication: 2014 Dec 09. - Publication Year :
- 2014
-
Abstract
- Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001). Femoral vascular access was associated with reduced filter life span (P=0.012), especially under heparin anticoagulation (P=0.015). Patients on RAC had higher rates of metabolic alkalosis (P=0.001), required more transfusions (P=0.045), and showed higher illness severity measured by SOFA scores (P=0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.
- Subjects :
- Aged
Anticoagulants adverse effects
Anticoagulants pharmacology
Blood Coagulation drug effects
Citric Acid adverse effects
Citric Acid pharmacology
Citric Acid therapeutic use
Female
Heparin adverse effects
Heparin pharmacology
Heparin therapeutic use
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Patient Admission
Renal Replacement Therapy adverse effects
Anticoagulants therapeutic use
Critical Care
Critical Illness
Intensive Care Units
Renal Dialysis adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1537-744X
- Volume :
- 2014
- Database :
- MEDLINE
- Journal :
- TheScientificWorldJournal
- Publication Type :
- Academic Journal
- Accession number :
- 25548793
- Full Text :
- https://doi.org/10.1155/2014/808320