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.

scholarly journals Tirofiban preserves platelet loss during continuous renal replacement therapy in a randomised prospective open-blinded pilot study

Critical Care ◽  
2008 ◽  
Vol 12 (4) ◽  
pp. R111 ◽  
Author(s):  
Andreas Link ◽  
Matthias Girndt ◽  
Simina Selejan ◽  
Ranja Rbah ◽  
Michael Böhm
Keyword(s):  
Renal Replacement Therapy ◽  
Pilot Study ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy

scholarly journals 1340. The Effect of Continuous Renal Replacement Therapy on Body Temperature in Patients with and without Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S485-S485
Author(s):  
Douglas W Challener ◽  
Kianoush Kashani ◽  
John C O’Horo
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Generation Cephalosporin ◽  
Temperature Data ◽  
Fourth Generation ◽  
Antibiotic Administration ◽  
Mean Temperature ◽  
The Mean

Abstract Background Sepsis frequently leads to acute kidney injury. In severe cases, patients may require continuous renal replacement therapy (CRRT) which involves placement of a dialysis catheter and an extracorporeal blood filtration circuit. CRRT is commonly considered to “mask” fever, though this phenomenon has not been investigated. Methods We queried an institutional database of all patients on CRRT from 2007 to 2015 for inpatient temperature data and antibiotic administration records. Receipts of piperacillin–tazobactam, a carbapenem, or a third or fourth-generation cephalosporin, indicating a serious infection, were considered intervention arm. We analyzed temperatures recorded in the intensive care unit before, during, and after CRRT. Patients were divided into groups that did not receive antibiotics as well as those who did. Temperature data were Winsorized to correct for outliers. We also performed descriptive statistics for each group. Results There were 237,988 temperature readings for 1,568 ICU patients on CRRT. 1,153 patients received broad-spectrum antibiotics in ICU. In patients who received antibiotics in ICU and were presumed to have an infection, the mean temperature was 37.2°C prior to initiation of CRRT, 36.8°C while on CRRT, and 37.2°C following discontinuation of CRRT. In the 415 patients who did not receive IV antibiotics, the mean temperature was 36.9°C prior to initiation of CRRT, 36.6°C while on CRRT, and 37.0°C following discontinuation of CRRT. During each of the periods before, during, and after CRRT, patients who received antibiotics had significantly higher temperatures than those who did not (P < 0.001). Patients receiving antibiotics were generally younger (mean 60 years vs. 64 years, P < 0.001), had longer ICU stays (mean 29 days vs. 12 days, P < 0.001) and spent more time being ventilated (mean 23 days vs. 7 days, P < 0.001). The mean SOFA score on day one was similar (mean 11.1 in the antibiotic group and 10.5 in the other group). Conclusion This investigation suggests that patients have slightly lower temperatures while on CRRT, by on average less than half a degree. A similar effect is seen in both patients with infections as well as those without. Further work will be needed to determine what constitutes a true febrile response in this population. Disclosures All authors: No reported disclosures.

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.

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 Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

Renal Failure ◽  
2007 ◽  
Vol 29 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Jürgen Birnbaum ◽  
Claudia D. Spies ◽  
Edda Klotz ◽  
Ortrud Vargas Hein ◽  
Stanislao Morgera ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Pilot Study ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy
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