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Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6584631. [PMID: 35663201 PMCID: PMC9159835 DOI: 10.1155/2022/6584631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
By reason of surgical demand, the majority of cardiovascular procedures still depend on the use of cardiopulmonary bypass (CPB). Due to the nonphysiological state of CPB, it can cause complex and unpredictable inflammatory response, which may lead to significant morbidity and mortality. Unfortunately, the pharmacological and mechanical strategies that currently exist do not offer significant advantages in controlling inflammatory response and improving patient outcomes. The best strategy to reduce inflammation in CPB is still uncertain. In recent years, adsorptive blood purification techniques (BPTs) have emerged, among which CytoSorb is the latest representative device. Currently, the primary application area of adsorptive BPTs is in the control and treatment of systemic hyperinflammatory states, such as refractory septic shock patients. However, the evidences on efficacy and safety of adsorptive BPTs application during CPB surgery are still inconclusive, so we summarize the relevant evidences here and suggest future potential research areas.
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Samoni S, Husain-Syed F, Villa G, Ronco C. Continuous Renal Replacement Therapy in the Critically Ill Patient: From Garage Technology to Artificial Intelligence. J Clin Med 2021; 11:172. [PMID: 35011913 PMCID: PMC8745413 DOI: 10.3390/jcm11010172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 11/17/2022] Open
Abstract
The history of continuous renal replacement therapy (CRRT) is marked by technological advances linked to improvements in the knowledge of the mechanisms and kinetics of extracorporeal removal of solutes, and the pathophysiology of acute kidney injury (AKI) and other critical illnesses. In the present article, we review the main steps in the history of CRRT, from the discovery of continuous arteriovenous hemofiltration to its evolution into the current treatments and its early use in the treatment of AKI, to the novel sequential extracorporeal therapy. Beyond the technological advances, we describe the development of new medical specialties and a shared nomenclature to support clinicians and researchers in the broad and still evolving field of CRRT.
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Affiliation(s)
- Sara Samoni
- Department of Nephrology and Dialysis, S. Anna Hospital, ASST Lariana, 22042 Como, Italy;
| | - Faeq Husain-Syed
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, 35392 Giessen, Germany;
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence, 50134 Florence, Italy
| | - Claudio Ronco
- Department of Medicine (DIMED), University of Padova, 35121 Padova, Italy;
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), St. Bortolo Hospital, 36100 Vicenza, Italy
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Buccione E, Guzzi F, Colosimo D, Tedesco B, Romagnoli S, Ricci Z, L'Erario M, Villa G. Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes. Front Pediatr 2021; 9:696798. [PMID: 34195164 PMCID: PMC8236631 DOI: 10.3389/fped.2021.696798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Severe acute kidney injury is a common finding in the Pediatric Intensive Care Unit (PICU), however, Continuous Renal Replacement Therapy (CRRT) is rarely applied in this setting. This study aims to describe our experience in the rate of application of CRRT, patients' clinical characteristics at admission and CRRT initiation, CRRT prescription, predictors of circuit clotting, short- and long-term outcomes. Methods: A 6-year single center retrospective study in a tertiary PICU. Results: Twenty-eight critically ill patients aged 0 to 18 years received CRRT between January 2012 and December 2017 (1.4% of all patients admitted to PICU). Complete clinical and CRRT technical information were available for 23/28 patients for a total of 101 CRRT sessions. CRRT was started, on average, 40 h (20-160) after PICU admission, mostly because of fluid overload. Continuous veno-venous hemodiafiltration and systemic heparinization were applied in 83.2 and 71.3% of sessions, respectively. Fifty-nine sessions (58.4%) were complicated by circuit clotting. At multivariate Cox-regression analysis, vascular access caliber larger than 8 Fr [HR 0.37 (0.19-0.72), p = 0.004] and regional citrate anticoagulation strategy [HR 0.14 (0.03-0.60), p = 0.008] were independent protective factors for clotting. PICU mortality rate was 42.8%, and six survivors developed chronic kidney disease (CKD), within an average follow up of 3.5 years. Conclusions: CRRT is uncommonly applied in our PICU, mostly within 2 days after admission and because of fluid overload. Larger vascular access and citrate anticoagulation are independent protective factors for circuit clotting. Patients' PICU mortality rate is high and survival often complicated by CKD development.
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Affiliation(s)
- Emanuele Buccione
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy.,Neonatal Intensive Care Unit, AUSL Pescara, Pescara, Italy
| | - Francesco Guzzi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Denise Colosimo
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy
| | - Brigida Tedesco
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy
| | - Stefano Romagnoli
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, AOU Careggi, Florence, Italy
| | - Zaccaria Ricci
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy.,Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | - Manuela L'Erario
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy
| | - Gianluca Villa
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, AOU Careggi, Florence, Italy
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Samman KN, Baalbaki H, Bouchard J, Albert M. Continuous Renal Replacement Therapy with oXiris® Membrane in Severe Ebstein-Barr Virus-Mediated Hemophagocytic Lymphohistiocytosis: A Case Report. Blood Purif 2020; 50:578-581. [PMID: 33333505 DOI: 10.1159/000511724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH), a life-threatening disease with uncontrolled immune activation and inflammatory reaction, often leads to a deadly cytokine storm. In severe Ebstein-Barr virus-triggered HLH receiving standard immunosuppression, continuous renal replacement therapy (CRRT) with oXiris® blood purification membrane resulted in a timely reduction of inflammatory markers and discontinuation of vasopressors. To our knowledge, this is the first report of successful use of the oXiris® membrane in HLH.
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Affiliation(s)
- Karla N Samman
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Hussein Baalbaki
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Josée Bouchard
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Martin Albert
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada, .,Groupe ERESI, Hôpital du Sacré-Cœur de Montréal Research Center, Montreal, Québec, Canada,
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Villa G, Romagnoli S, De Rosa S, Greco M, Resta M, Pomarè Montin D, Prato F, Patera F, Ferrari F, Rotondo G, Ronco C. Blood purification therapy with a hemodiafilter featuring enhanced adsorptive properties for cytokine removal in patients presenting COVID-19: a pilot study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:605. [PMID: 33046113 PMCID: PMC7549343 DOI: 10.1186/s13054-020-03322-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
Background Systemic inflammation in COVID-19 often leads to multiple organ failure, including acute kidney injury (AKI). Renal replacement therapy (RRT) in combination with sequential extracorporeal blood purification therapies (EBP) might support renal function, attenuate systemic inflammation, and prevent or mitigate multiple organ dysfunctions in COVID-19. Aim Describe overtime variations of clinical and biochemical features of critically ill patients with COVID-19 treated with EBP with a hemodiafilter characterized by enhanced cytokine adsorption properties. Methods An observational prospective study assessing the outcome of patients with COVID-19 admitted to the ICU (February to April 2020) treated with EBP according to local practice. Main endpoints included overtime variation of IL-6 and multiorgan function-scores, mortality, and occurrence of technical complications or adverse events. Results The study evaluated 37 patients. Median baseline IL-6 was 1230 pg/ml (IQR 895) and decreased overtime (p < 0.001 Kruskal-Wallis test) during the first 72 h of the treatment, with the most significant decrease in the first 24 h (p = 0.001). The reduction in serum IL-6 concentrations correlated with the improvement in organ function, as measured in the decrease of SOFA score (rho = 0.48, p = 0.0003). Median baseline SOFA was 13 (IQR 6) and decreased significantly overtime (p < 0.001 at Kruskal-Wallis test) during the first 72 h of the treatment, with the most significant decrease in the first 48 h (median 8 IQR 5, p = 0.001). Compared to the expected mortality rates, as calculated by APACHE IV, the mean observed rates were 8.3% lower after treatment. The best improvement in mortality rate was observed in patients receiving EBP early on during the ICU stay. Premature clotting (running < 24 h) occurred in patients (18.9% of total) which featured higher effluent dose (median 33.6 ml/kg/h, IQR 9) and higher filtration fraction (median 31%, IQR 7.4). No electrolyte disorders, catheter displacement, circuit disconnection, unexpected bleeding, air, or thromboembolisms due to venous cannulation of EBP were recorded during the treatment. In one case, infection of vascular access occurred during RRT, requiring replacement. Conclusions EBP with heparin-coated hemodiafilter featuring cytokine adsorption properties administered to patients with COVID-19 showed to be feasible and with no adverse events. During the treatment, patients experienced serum IL-6 level reduction, attenuation of systemic inflammation, multiorgan dysfunction improvement, and reduction in expected ICU mortality rate.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy. .,Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.,Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Massimiliano Greco
- Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Marco Resta
- Department of General Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Diego Pomarè Montin
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Federico Prato
- Anesthesia and Intensive Care, Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Francesco Patera
- Department of Nephrology, Dialysis and Transplantation Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Anaesthesia and Intensive Care Unit, IRCCS San Matteo Hospital and University of Pavia, Pavia, Italy
| | | | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, Università di Padova, Padova, Italy.,Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
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Zhang H, Zhu G, Yan L, Lu Y, Fang Q, Shao F. The absorbing filter Oxiris in severe coronavirus disease 2019 patients: A case series. Artif Organs 2020; 44:1296-1302. [PMID: 32779737 PMCID: PMC7404740 DOI: 10.1111/aor.13786] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/27/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Abstract
Hypercytokines cause acute respiratory distress syndrome (ARDS) in coronavirus disease 2019 (COVID‐19) patients, which is the main reason for intensive care unit treatment and the leading cause of death in COVID‐19 patients. Cytokine storm is a critical factor in the development of ARDS. This study evaluated the efficacy and safety of Oxiris filter in the treatment of COVID‐19 patients. Five patients with COVID‐19 who received continuous renal replacement therapy (CRRT) in Henan provincial people's hospital between January 23, 2019 and March 28, 2020, were enrolled in this study. Heart rate (HR), mean arterial pressure (MAP), oxygenation index (PaO2/FiO2), renal function, C‐reactive protein (CRP), cytokines, procalcitonin (PCT), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure score (SOFA), and prognosis were compared after CRRT. Five COVID‐19 patients, three males and two females, aged 70.2 ± 19.6 years, were enrolled. After treatment, HR (101.4 ± 14.08 vs. 83.8 ± 6.22 bpm/min), CRP (183 ± 25.21 vs. 93.78 ± 70.81 mg/L), IL‐6 (3234.49 (713.51, 16038.36) vs. 181.29 (82.24, 521.39) pg/mL), IL‐8 (154.86 (63.97, 1476.1) vs. 67.19 (27.84, 85.57) pg/mL), and IL‐10 (17.43 (9.14, 41.22) vs. 4.97 (2.39, 8.70) pg/mL), APACHE II (29 ± 4.92 vs. 18.4 ± 2.07), and SOFA (17.2 ± 1.92 vs. 11.2 ± 3.4) significantly decreased (P < .05), while MAP (75.8 ± 4.92 vs. 85.8 ± 6.18 mm Hg), and PaO2/FiO2 (101.2 ± 7.49 vs. 132.6 ± 26.15 mm Hg) significantly increased (P < .05). Among the five patients, negative conversion of nucleic acid test was found in three cases, while two cases died. No adverse events occurred during the treatment. Our study observed a reduced level of overexpressed cytokines, stabilization of hemodynamic status, and staged improvement of organ function during the treatment with Oxiris filter.
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Affiliation(s)
- Hongtao Zhang
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Guizhen Zhu
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Yan
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Lu
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiying Fang
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengmin Shao
- Department of Nephrology, The People's Hospital of Zhengzhou University, Zhengzhou, China
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