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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

      Submit here before September 30, 2024

      About Blood Purification: 2.2 Impact Factor I 5.8 CiteScore I 0.782 Scimago Journal & Country Rank (SJR)

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      Successful Treatment of Crush Syndrome Complicated with Multiple Organ Dysfunction Syndrome Using Hybrid Continuous Renal Replacement Therapy

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          Abstract

          Background: The M8.1 ‘Wenchuan’ earthquake occurred on May 12th 2008 causing many injuries and casualties. We report a case with crush syndrome and multiple organ dysfunction syndrome (MODS) successfully treated with hybrid continuous renal replacement therapy (CRRT). Method: The patient is a 16-year-old female who was rescued from a collapsed building after 17 h. Emergency amputation was performed. Infections and crush syndrome caused sepsis, acute respiratory distress syndrome, acute renal failure, heart failure, liver dysfunction and disseminated intravascular coagulation in a short time. Hybrid CRRT including high volume hemofiltration, low temperature blood purification, hemoperfusion using endotoxin adsorbent as well as plasmapheresis was performed. Result: After the hybrid CRRT treatment, the patient’s condition improved progressively. Functions of lung, heart, liver and kidney recovered. Sepsis was controlled. CRRT treatment continued for 550 h without stop. She was followed up for 6 months without any sign of residual organ dysfunction. Conclusion: Hybrid CRRT is an effective treatment for patients with severe crush syndrome complicated with MODS.

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          Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review

          Dinna Cruz, Mark A. Perazella, Rinaldo Bellomo … (2007)
          Introduction Severe sepsis and septic shock are common problems in the intensive care unit and carry a high mortality. Endotoxin, one of the principal components on the outer membrane of gram-negative bacteria, is considered important to their pathogenesis. Polymyxin B bound and immobilized to polystyrene fibers (PMX-F) is a medical device that aims to remove circulating endotoxin by adsorption, theoretically preventing the progression of the biological cascade of sepsis. We performed a systematic review to describe the effect in septic patients of direct hemoperfusion with PMX-F on outcomes of blood pressure, use of vasoactive drugs, oxygenation, and mortality reported in published studies. Methods We searched PubMed, the Cochrane Collaboration Database, and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Prospective and retrospective observational studies, pre- and post-intervention design, and randomized controlled trials were included. Three authors reviewed all citations. We identified a total of 28 publications – 9 randomized controlled trials, 7 non-randomized parallel studies, and 12 pre-post design studies – that reported at least one of the specified outcome measures (pooled sample size, 1,425 patients: 978 PMX-F and 447 conventional medical therapy). Results Overall, mean arterial pressure (MAP) increased by 19 mm Hg (95% confidence interval [CI], 15 to 22 mm Hg; p < 0.001), representing a 26% mean increase in MAP (range, 14% to 42%), whereas dopamine/dobutamine dose decreased by 1.8 μg/kg per minute (95% CI, 0.4 to 3.3 μg/kg per minute; p = 0.01) after PMX-F. There was significant intertrial heterogeneity for these outcomes (p < 0.001), which became non-significant when analysis was stratified for baseline MAP. The mean arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio increased by 32 units (95% CI, 23 to 41 units; p < 0.001). PMX-F therapy was associated with significantly lower mortality risk (risk ratio, 0.53; 95% CI, 0.43 to 0.65). The trials assessed had suboptimal method quality. Conclusion Based on this critical review of the published literature, direct hemoperfusion with PMX-F appears to have favorable effects on MAP, dopamine use, PaO2/FiO2 ratio, and mortality. However, publication bias and lack of blinding need to be considered. These findings support the need for further rigorous study of this therapy.
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            Management of crush-related injuries after disasters.

            Norbert Lameire, Mehmet Sukru Sever, Raymond Vanholder (2006)
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              High-volume haemofiltration in human septic shock.

              Amy Cole, D Journois, Anthony P. Davenport … (2001)
              To evaluate whether high volume haemofiltration improves haemodynamics and affects serum cytokine and complement concentrations in human septic shock. Randomized cross-over clinical trial in a tertiary intensive care unit. Eleven patients with septic shock and multi-organ failure. Patients were assigned to either 8 h of high-volume haemofiltration (HVHF; 6 l/h) or 8 h of standard continuous veno-venous haemofiltration (CVVH; 1 l/h) in random order. We measured changes in haemodynamic variables, dose of norepinephrine required to maintain a mean arterial pressure greater than 70 mmHg and plasma concentrations of complement anaphylatoxins and several cytokines. An 8-h period of HVHF was associated with a greater reduction in norepinephrine requirements than a similar period of CVVH (median reduction: 10.5 vs. 1.0 microg/min; p = 0.01; median percentage reduction: 68 vs. 7%; p = 0.02). Both therapies were associated with a temporary reduction (p < 0.01) in the plasma concentration of C3a, C5a, and interleukin 10 within 2 h of initiation. HVHF was associated with a greater reduction in the area under the curve for C3a and C5a (p < 0.01). The concentration of the measured soluble mediators in the ultrafiltrate was negligible. HVHF decreases vasopressor requirements in human septic shock and affects anaphylatoxin levels differently than standard CVVH.
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                Author and article information

                Journal
                Journal ID (publisher-id): BPU
                Journal ID (nlm-ta): Blood Purif
                Journal ID (doi): 10.1159/issn.0253-5068
                Title: Blood Purification
                Publisher: S. Karger AG
                ISSN (Print): 0253-5068
                ISSN (Electronic): 1421-9735
                Publication date Subscription-year: 2009
                Publication date (Print): October 2009
                Publication date (Electronic): 07 July 2009
                Volume: 28
                Issue: 3
                Pages: 175-180
                Affiliations
                Department of Medicine, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, China
                Article
                Publisher ID: 227786 Other ID: Blood Purif 2009;28:175–180
                DOI: 10.1159/000227786
                PubMed ID: 19597302
                SO-VID: 04b9db27-9079-4e0d-be08-71e871874001
                Copyright © © 2009 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 26 March 2009
                Date accepted : 21 April 2009
                Page count
                Figures: 3, References: 20, Pages: 6
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Hybrid continuous renal replacement therapy,Crush syndrome,Multiple organ dysfunction syndrome
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Hybrid continuous renal replacement therapy, Crush syndrome, Multiple organ dysfunction syndrome

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