123 A COMPARISON STUDY BETWEEN PRISMASOL SOLUTION AND SELF-IMPROVISED REGIME USING NORMAL SALINE, HARTMANN SOLUTION AND DEXTROSED BASED LACTATE SOLUTION IN CONTINUOUS RENAL REPLACEMENT THERAPY

Abstract

NMRR-16-694-29424 Category: RRT Technique Characteristics Presenter: Dr KENG-HEE KOH Keyword: Prismasol; self-improvised regime; CRRT Corresponding Author: Koh Keng Hee (email: [email protected]) Continuous Renal Replacement Therapy (CRRT) for critically ill and hemodynamically unstable patients with Primasol solutions are well established regime. We used self-improvised regime as a substitute of prismasol solution after finishing stock of prismasol. Our self improvised regime utilizes normal saline, dextrose based lactate solution, hartmann solution and bicarbonate infusion. To compare the survival rate of self-revised CRRT compared to conventional CRRT. To compare blood pressure, carbon dioxide and bicarbonate retention, risk of hypoglycemia and duration of assisted ventilation with different CRRT regime. All adult cases with history of admission to intensive care unit and had undergone CVVH from January 2016 till April 2017 were identified and a retrospective study is performed. In this study, 72 patients were admitted to intensive care unit and undergone CRRT between January 2016 and April 2017. We only managed to retrieve 52 medical case notes from the medical record unit. There were 36 males and 16 females in this study with the median age of 54 years old. Majority of the patients (n=41,78.9%) were having sepsis, remaining of the patients was diagnosed to have intracranial bleeding (n=4, 7.7%), perforated viscus(n=3, 5.8%), polytrauma (n=2, 3.9%) and others. Out of the 40 patients who have survived more than 24 hours, 22 and 18 of them received prismasol and self-revised regime respectively. Comparisons of the outcome show that there was no difference in regards to bicarbonate level, blood pressure measurement nor risk of hypoglycemia in both group (Table 1). It showed that mean carbon dioxide level was higher in the prismasol group (mean=51.0mmHg/kPa) than the self-revised group (mean=42.7mmHg/kPa) though it was not statistically significant. Nevertheless, there was not much difference in terms of assisted ventilation duration with mean reading of 8 days and 10 days respectively. Overall, there were 19/24 subjects (79%) died in the prismasol group and 24/28 subjects (86%) died in the second group (p=0.716). Both cohorts have no differences in term of Sequential Organ Failure Assessment (SOFA) score, age, Hb and albumin levels. Although initial urea level is higher in prismasol versus self-improvised regime, adjusted univariate analysis (of survived versus fatal patients) followed by multivariate logistic regression shows that the both CRRT regime did not have differences in survival. In these cohorts, there is no much difference between prismasol and self-improvised regime group in terms of survival rate and pCO2 retention, or risk of hypoglycemia. In case of resources limitation, self improvised regime is a viable option but one need to perform surveillance to ensure acceptable survival outcome.Table 1Comparison of Outcomes between Prismasol regime and Self-improvised regimePrismasol regimeSelf-improvised regimep-valueSystolic Blood pressure (mmHg)Pre-CRRT115±21118±180.663Post-CRRT115±19125±160.076Bicarbonate level (mmol/L)Pre-CRRT12.8±4.411.3±4.70.303Post-CRRT17.3±4.815.1±5.10.135Glucose level (mmol/L)Pre-CRRT10.5±5.09.5±5.20.535Post-CRRT8.8±3.38±2.90.432Carbon dioxide level (mmHg/kPa)Pre-CRRT43.8±12.933.2±15.30.022Post-CRRT51±42.742.3±14.90.932Duration of assisted ventilation after CRRT initiation (days)8±610±90.411mean ± standard deviation are shown and comparison is with t-test.Note: Post level was taken a day after CRRT commencement Open table in a new tab