Comparison of the Accuracy of the Novel PrisMax Continuous Renal Replacement Therapy System to the Classic Prismaflex System

2018 ◽  
Vol 47 (1-3) ◽  
pp. 166-170 ◽  
Author(s):  
Max Bell ◽  
Marcus Broman ◽  
Olivier Joannes-Boyau ◽  
Claudio Ronco
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Treatment Time ◽  
Raw Material ◽  
The Novel ◽  
Dose Delivery ◽  
Delivery Methods ◽  
Multicentre Setting ◽  
Delivered Dose

Background/Aims: We assessed how the novel PrisMax continuous renal replacement therapy (CRRT) system performed in an international multicentre setting. The system has multiple novel tools aiming to increase accuracy and dose delivery. Methods: Data was prospectively collected from 7 intensive care units in 6 countries. The PrisMax device data logs constituted the raw material and last generation Prismaflex data was used as comparison. Clinical parameters like treatment time, filter life span, downtime as well as prescribed and delivered dose were recorded. Results: PrisMax delivered/prescribed effluent ratios (mean ± SD) 0.92 ± 0.15 vs. Prismaflex ratios 0.85 ± 0.21, p < 0.001; delivered effluent dose (mL/kg/h) was 18.16 ± 12.93 vs. 10.95 ± 10.96, p < 0.0001; and (Kt/V) 0.76 ± 0.52 vs. 0.44 ± 0.44, p < 0.0001. Moreover, downtime was 27 minutes less for the newer device. Conclusion: The PrisMax CRRT device outperforms its predecessor with regard to dose delivery and accuracy.

scholarly journals The Novel PrisMax Continuous Renal Replacement Therapy System in a Multinational, Multicentre Pilot Setting

2018 ◽  
Vol 46 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Marcus Broman ◽  
Max Bell ◽  
Olivier Joannes-Boyau ◽  
Claudio Ronco
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
User Satisfaction ◽  
Treatment Time ◽  
Journal Club ◽  
Raw Material ◽  
The Novel ◽  
User Friendliness ◽  
Filter Life

Background/Aims: We assessed how the novel PrisMax continuous renal replacement therapy (CRRT) system performed in a prospective international multicentre setting. We compared this device to its predecessor, the Prismaflex, with regards to multiple treatment parameters. Additionally, we performed a survey, aiming to measure user satisfaction. Methods: Data was prospectively collected from 7 intensive care units (ICU) in 6 countries. The PrisMax device data logs constituted the raw material. Clinical parameters like treatment time, filter life span, downtime, delivered dose and number and type of alarms were recorded. A user questionnaire was sent out to 3 of the participating ICUs. Results: Filter life, downtime, blood pump stops, bag changing time and number of malfunction alarms showed significantly improved values compared to the historic Prismaflex data. The survey showed high scores with regards to user friendliness. Conclusion: The PrisMax CRRT device is safe and outperformed its’ previous generation counterpart in virtually all aspects. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=489213.

scholarly journals ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study)

2019 ◽  
Vol 48 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Mauro Neri ◽  
Anna Lorenzin ◽  
Massimo de Cal ◽  
Alessandra Brendolan ◽  
Nicola Marchionna ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Pilot Study ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Treatment Duration ◽  
Fourth Generation ◽  
Average Percentage ◽  
Total Treatment Time ◽  
Total Treatment ◽  
Delivered Dose

Background: ACUsmart (Medica S.P.A., Italy) is a new-generation, continuous renal replacement therapy (CRRT) machine for critically ill patients with acute kidney injury. We designed a multicenter international pilot study to provide a description of outlines of the ACUsmart system, evaluation aspects of functionality, usability, and feasibility, discriminating reasons of possible treatment’s withdrawals or discontinuations and highlighting strong and weak points of the machine. Methods: Data of 23 CRRT (and 11 plasma exchange) treatments were collected from 4 intensive care units. Parameters such as treatment duration, downtime, delivered dose, and number and type of alarms were recorded. The general perception of the machine was quantified through the administration of a survey to each component of the evaluating staff. Results: A total treatment time of 447 h was carried with ACUsmart. Eleven continuous veno-venous hemofiltration, 4 continuous veno-venous hemodialysis , and 8 continuous veno-venous hemodiafiltration were performed. The average percentage of net treatment duration with respect to total treatment duration was 92.37%. The mean prescribed dose and delivered dose were 26.33 and 24.10 mL/kg/h, respectively. In general, the machine was rated by users involved as practical and easy to use, although few components need to be slightly improved. Conclusion: ACUsmart is a new multifunctional machine that meets most of the features required in a fourth-generation CRRT equipment.

Use of Fluoride as a Marker Solute to Quantify the Current Effective Delivered Dose in Continuous Renal Replacement Therapy: An “in vitro” Study

2020 ◽  
Vol 49 (6) ◽  
pp. 685-691
Author(s):  
Gianluca Villa ◽  
Vittorio Bocciero ◽  
Mauro Neri ◽  
Diego Pomarè Montin ◽  
Elena Angeli ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
In Vitro Study ◽  
Experimental Models ◽  
Vitro Study ◽  
Fluoride Removal ◽  
Routine Practice ◽  
Delivered Dose

<b><i>Background:</i></b> The <i>current effective delivered dose</i> is a quality indicator for continuous renal replacement therapy. Its periodic assessment might enable physicians to deliver personalised treatments. Yet, its quantification as by extracorporeal urea clearance (Cl) is cumbersome and thus often neglected in routine practice. The aim of this in vitro study is to demonstrate the non-inferior effectiveness of assessing the <i>current effective delivered dose</i> using a simpler, cheaper and faster approach based on measurement of fluoride rather than urea extracorporeal Cl. <b><i>Methods:</i></b> We compared urea and fluoride removal in 3 post-dilution continuous veno-venous haemofiltration (CVVH) and 3 continuous veno-venous haemodialysis (CVVHD) in vitro experimental models. Experiments ran for 180 min, using 3 L of human blood, heparin anticoagulation and a machine dose of 30 mL/kg/h. Urea and fluoride were measured in the inflow, outflow and effluent lines to compare sieving coefficients (SC), saturation coefficients (SA) and transmembrane Cls. <b><i>Results:</i></b> In CVVH, the median SC values were 1.06 (1.02–1.07) and 1.02 (1.01–1.04) for fluoride and urea, respectively (discrepancy of 4.3%), while transmembrane convective Cls were 31.28 (30.01–31.31) mL/kg/h and 30.30 (29–31.85) mL/kg/h (discrepancy of 3.13%), respectively. In CVVHD, the median SA values were 1.01 (0.96–1.02) and 1 (0.95–1.01) for fluoride and urea, respectively (discrepancy of 1.6%), while transmembrane dialytic Cls were 30.26 (29.52–31.32) mL/kg/h and 31.16 (30–31.75) mL/kg/h (discrepancy of –2.97%), respectively. <b><i>Conclusion:</i></b> Fluoride transmembrane removal was close to that observed with urea, in terms of SC, SA and transmembrane Cl. Fluoride seems as much accurate as urea in assessing the <i>current effective delivered dose</i> during both CVVH and CVVHD and might therefore be adopted for dose measurement. Besides accuracy, fluoride bedside assessment could present many advantages over urea, particularly in terms of availability, costs, time requirement and rapidity of assessment.

scholarly journals Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

2010 ◽  
Vol 6 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Rolando Claure-Del Granado ◽  
Etienne Macedo ◽  
Glenn M. Chertow ◽  
Sharon Soroko ◽  
Jonathan Himmelfarb ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Delivered Dose

scholarly journals Continuous Renal Replacement Therapy in the Critically Ill Patient: From Garage Technology to Artificial Intelligence

2021 ◽  
Vol 11 (1) ◽  
pp. 172
Author(s):  
Sara Samoni ◽  
Faeq Husain-Syed ◽  
Gianluca Villa ◽  
Claudio Ronco
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Critically Ill Patient ◽  
The Novel ◽  
Medical Specialties ◽  
Technological Advances ◽  
Continuous Arteriovenous Hemofiltration ◽  
History Of

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.

Actually Delivered Dose of Continuous Renal Replacement Therapy Is Underestimated in Hemofiltration

ASAIO Journal ◽  
2013 ◽  
Vol 59 (6) ◽  
pp. 622-626 ◽  
Author(s):  
Zhongheng Zhang ◽  
Hongying Ni ◽  
Haozhe Fan ◽  
Danyu Li ◽  
Xiao Xu
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Delivered Dose

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.

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