Regional Citrate Anticoagulation During Coupled Plasma Filtration and Adsorption May Increase Survival in Septic Shock

2018 ◽  
Vol 47 (1-3) ◽  
pp. 109-110
Author(s):  
Michele Claudio Vassallo ◽  
Fabiana Tartamella ◽  
Pradipta Bhakta
Keyword(s):  
Septic Shock ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Plasma Filtration

scholarly journals Regional Citrate Anticoagulation During Coupled Plasma Filtration and Adsorption May Increase Survival in Septic Shock

2018 ◽  
Vol 47 (1-3) ◽  
pp. 111-112
Author(s):  
Giorgio Berlot ◽  
Stefano Falini ◽  
Virginia Negro ◽  
Antoinette Agbedjro ◽  
Ariella Tomasini ◽  
...  
Keyword(s):  
Septic Shock ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Plasma Filtration

Feasibility and safety of combined cytokine adsorption and continuous veno-venous hemodialysis with regional citrate anticoagulation in patients with septic shock

2019 ◽  
Vol 43 (1) ◽  
pp. 10-16
Author(s):  
Thomas Dimski ◽  
Timo Brandenburger ◽  
Torsten Slowinski ◽  
Detlef Kindgen-Milles
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Adjunct Treatment ◽  
Citrate Anticoagulation ◽  
Acute Kidney Injury Stage ◽  
Norepinephrine Dose

Introduction: Septic shock is characterized by severe metabolic and hemodynamic alterations. It is often accompanied by acute kidney injury. A new adjunct treatment is hemoadsorption using a cytokine adsorber in line with continuous veno-venous renal replacement therapy. We studied the feasibility, efficacy, and safety of cytokine adsorption with citrate-anticoagulated continuous veno-venous hemodialysis (regional citrate anticoagulation–continuous veno-venous hemodialysis). Methods: In 11 patients with septic shock and acute kidney injury stage 3, we studied 12 cycles of cytokine adsorption and regional citrate anticoagulation–continuous veno-venous hemodialysis. We monitored parameters of citrate anticoagulation, circuit lifetime, laboratory parameters, hemodynamics, and vasopressor demand. Results: Ten out of 12 adsorber/continuous veno-venous hemodialysis circuits reached the target lifetime of 24 h for the adsorber. One system clotted and one was stopped for non-device-related reasons. Nine of the remaining continuous renal replacement therapy circuits reached 72 h lifetime. With default settings for regional citrate anticoagulation, serum ionized calcium and pH were in the normal range. Urea and creatinine were reduced significantly, and norepinephrine dose decreased from 0.47 (±0.09) to 0.16 (±0.04) µg/kg/min ( p = 0.016) after 24 h. Discussion: We show that combined cytokine adsorption/continuous veno-venous hemodialysis is effective to control pH, to reduce urea and creatinine, and to improve hemodynamics by reducing norepinephrine doses in patients with septic shock. It can be applied safely with standard settings of regional citrate anticoagulation rendering sufficiently long filter lifetimes for the adsorber and the continuous veno-venous hemodialysis circuit. Further studies are on the way to investigate whether these effects translate into improved outcomes in septic shock patients.

Regional Citrate Anticoagulation in Critically Ill Patients Treated with Plasma Filtration and Adsorption

2004 ◽  
Vol 22 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Filippo Mariano ◽  
Ciro Tetta ◽  
Maurizio Stella ◽  
Piera Biolino ◽  
Antonio Miletto ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Plasma Filtration

scholarly journals Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulation

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Patrik Schwarzer ◽  
Sven-Olaf Kuhn ◽  
Sylvia Stracke ◽  
Matthias Gründling ◽  
Stephan Knigge ◽  
...  
Keyword(s):  
Ionized Calcium ◽  
Regional Citrate Anticoagulation ◽  
Blood Gas ◽  
Citrate Anticoagulation ◽  
Post Filter

scholarly journals Early warning of citric acid overdose and timely adjustment of regional citrate anticoagulation based on machine learning methods

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Huan Chen ◽  
Yingying Ma ◽  
Na Hong ◽  
Hao Wang ◽  
Longxiang Su ◽  
...  
Keyword(s):  
Machine Learning ◽  
Citric Acid ◽  
Early Warning ◽  
Regional Citrate Anticoagulation ◽  
Support Vector ◽  
Learning Methods ◽  
Citrate Anticoagulation ◽  
Replacement Fluid ◽  
Machine Learning Methods ◽  
Neutral Networks

Abstract Background Regional citrate anticoagulation (RCA) is an important local anticoagulation method during bedside continuous renal replacement therapy. To improve patient safety and achieve computer assisted dose monitoring and control, we took intensive care units patients into cohort and aiming at developing a data-driven machine learning model to give early warning of citric acid overdose and provide adjustment suggestions on citrate pumping rate and 10% calcium gluconate input rate for RCA treatment. Methods Patient age, gender, pumped citric acid dose value, 5% NaHCO3 solvent, replacement fluid solvent, body temperature value, and replacement fluid PH value as clinical features, models attempted to classify patients who received regional citrate anticoagulation into correct outcome category. Four models, Adaboost, XGBoost, support vector machine (SVM) and shallow neural network, were compared on the performance of predicting outcomes. Prediction results were evaluated using accuracy, precision, recall and F1-score. Results For classifying patients at the early stages of citric acid treatment, the accuracy of neutral networks model is higher than Adaboost, XGBoost and SVM, the F1-score of shallow neutral networks (90.77%) is overall outperformed than other models (88.40%, 82.17% and 88.96% for Adaboost, XGBoost and SVM). Extended experiment and validation were further conducted using the MIMIC-III database, the F1-scores for shallow neutral networks, Adaboost, XGBoost and SVM are 80.00%, 80.46%, 80.37% and 78.90%, the AUCs are 0.8638, 0.8086, 0.8466 and 0.7919 respectively. Conclusion The results of this study demonstrated the feasibility and performance of machine learning methods for monitoring and adjusting local regional citrate anticoagulation, and further provide decision-making recommendations to clinicians point-of-care.

Clinical Impact of Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy in Critically Ill Patients

2017 ◽  
Vol 40 (12) ◽  
pp. 676-682 ◽  
Author(s):  
Maria Huguet ◽  
Lida Rodas ◽  
Miquel Blasco ◽  
Luis F. Quintana ◽  
Jordi Mercadal ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Red Blood Cell Transfusion ◽  
Regional Citrate Anticoagulation ◽  
Transfusion Rate ◽  
Metabolic Disturbances ◽  
Heparin Group ◽  
Metabolic Complications ◽  
Citrate Anticoagulation

Background Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Methods Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. Results 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. Conclusions These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

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