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Regional citrate anticoagulation in critically Ill patients treated with plasma filtration and adsorption
- Publication Year :
- 2004
-
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.
- 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
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....57f560fff4b35b590a20ae96f50add70