scholarly journals Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single-session therapeutic plasma exchange

2011 ◽  
Vol 26 (4) ◽  
pp. 214-215 ◽  
Author(s):  
Tibor Fülöp ◽  
Adrian Cosmin ◽  
Luis A. Juncos
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Extracorporeal Circuit ◽  
Single Session

Tandem Therapeutic Plasma Exchange Reduces Continuous Renal Replacement Therapy Downtime

2021 ◽  
pp. 1-8
Author(s):  
Matthew J. Foglia ◽  
Jonathan H. Pelletier ◽  
Hülya Bayir ◽  
Annette Fleck ◽  
Leslie Konyk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Plasma Exchange ◽  
Treatment Time ◽  
Kidney Injury ◽  
Therapeutic Plasma Exchange ◽  
Factors Associated ◽  
Multivariable Logistic Regression

<b><i>Introduction:</i></b> Continuous renal replacement therapy (CRRT) has become a primary treatment of severe acute kidney injury in children admitted to the intensive care unit. CRRT “downtime” (when the circuit is not active) can represent a significant portion of the prescribed treatment time and adversely affects clearance. The objective of this study was to evaluate factors associated with CRRT “downtime” and to determine whether instituting a tandem therapeutic plasma exchange (TPE) protocol could significantly and robustly decrease circuit downtime in patients receiving both therapies. <b><i>Methods:</i></b> This is a retrospective cohort study of 116 patients undergoing CRRT in the pediatric, neonatal, or cardiac ICU at UPMC Children’s Hospital of Pittsburgh from January 2014 to July 2020. We performed multivariable logistic regression to determine factors associated with CRRT downtime. We instituted a tandem TPE protocol whereby TPE and CRRT could run in parallel without pausing CRRT in April 2018. We analyzed the effect of the protocol change by plotting downtime for patients undergoing CRRT and TPE on a run chart. The effect of initiating tandem TPE on downtime was assessed by special cause variation. <b><i>Results:</i></b> For 108/139 (77.7%) sessions with downtime data available, the median (IQR) percentage of downtime was 6.2% (1.7–12.7%). Multivariable logistic regression showed that TPE was significantly associated with CRRT downtime (<i>p</i> = 0.003), and that age, sex, race, catheter size, and anticoagulation were not. For patients undergoing TPE, the median (IQR) percentage of downtime was 14.7% (10.5–26%) and 3.4% (1.3–4.9%) before and after initiation of tandem TPE, respectively (<i>p</i> &#x3c; 0.001). The difference in downtime percentage met criteria for special cause variation. <b><i>Conclusions:</i></b> Interruptions for TPE increase CRRT downtime. Tandem TPE significantly reduces CRRT downtime in patients undergoing both procedures concomitantly.

scholarly journals Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 350
Author(s):  
Fatih Aygün ◽  
Fatih Varol ◽  
Cansu Durak ◽  
Mey Talip Petmezci ◽  
Alper Kacar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Demographic Data ◽  
Therapeutic Plasma Exchange ◽  
Critically Ill Children

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged <18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.

Continuous Renal Replacement Therapy and Anticoagulation:

2016 ◽  
Vol 36 (2) ◽  
pp. 34-41 ◽  
Author(s):  
Susan Dirkes ◽  
Rob Wonnacott
Keyword(s):  
Intensive Care Unit ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Standard Treatment ◽  
Kidney Injury ◽  
Physiological Saline ◽  
Thrombin Inhibitors ◽  
Extracorporeal Circuit ◽  
Heparin Infusion

Continuous renal replacement therapy is currently used as a standard treatment for acute kidney injury in the intensive care unit, particularly for patients with unstable hemodynamic status. Because this therapy is continuous, for days or weeks, and the extracorporeal blood circuit is large, the circuit is prone to clotting. Several methods of keeping the extracorporeal circuit patent are available, including heparin infusion, flushes with physiological saline, use of thrombin inhibitors, and citrate. This article reviews methods for continuous renal replacement therapy, anticoagulation, efficacy, and implications for bedside critical care.

scholarly journals Effect of Dynamic Circuit Pressures Monitoring on the Lifespan of Extracorporeal Circuit and the Efficiency of Solute Removal During Continuous Renal Replacement Therapy

2020 ◽  
Author(s):  
Peiyun Li ◽  
Ling Zhang ◽  
Li Lin ◽  
Xin Tang ◽  
Mingjing Guan ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Dynamic Pressure ◽  
Regional Citrate Anticoagulation ◽  
Extracorporeal Circuit ◽  
Cox Regression Analysis ◽  
Extracorporeal Circuits ◽  
Removal Efficiencies

Abstract Objective: To observe the effects of dynamic pressure monitoring on the lifespan of the extracorporeal circuit and the efficiency of solute removal during continuous renal replacement therapy (CRRT).Materials and Methods: A prospective observational study was performed at the West China Hospital of Sichuan University in the intensive care unit. Analyses of the downloaded pressure data recorded by CRRT machines and the solute removal efficiencies, calculated by 2*Ce/(Cpre+Cpost), where Ce, Cpre and Cpost are the concentrations of the effluent, pre-filter blood, and post-filter blood, respectively, were performed. Samples were collected at 0, 2, 6, 12, 24 h after the initiation of CRRT. We measured the concentrations of creatinine, blood urea nitrogen (BUN) and β2-microglobulin in the plasma and effluent.Results: Extracorporeal circuits characterized by moderate-severe (M-S) access outflow dysfunction (AOD) events, defined as access outflow pressure less than or equal to -200 mm Hg more than 5mins, had shorter lifespans with no anticoagulation (17.6±11.2 h vs. 35.1±17.1 h, P=0.001) or with regional citrate anticoagulation (RCA) (40.3±22.2 h vs. 55.9±21.7 h, P=0.016). Moreover, Cox regression analysis revealed that the lack of moderate-severe AOD events, RCA, or continuous veno-venous hemodiafiltration (CVVHDF) independently prolonged the circuit lifespan. All tested solutes removal efficiencies started to decline at 12h. Furthermore, efficiencies of all solutes removal dropped obviously at 24h when TMP≥ 150mmHg.Conclusion: RCA and CVVHDF predicted a longer circuit lifespan. Moderate-severe AOD events were associated with a shorter circuit lifespan when RCA or no anticoagulation was used. Replacement of extracorporeal circuit might be considered if TMP≥ 150mmHg at 24h.

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