Abstract
BackgroundPrevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid–base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF.Methods34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acid–base regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2).ResultsMedian number of treatment sessions was 2 (range 1–9) per patient. Median duration of treatment was 17.5 (IQR 11–23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO3− and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3− and PaCO2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively.ConclusionsIn this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid–base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.
Highlights
Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high
Recent publications indicate that more than 60% of these patients did not survive their stay at the intensive care unit (ICU) [1, Fuhrmann et al Ann
Patient characteristics Thirty-four patients that were consecutively treated with the Advanced Organ Support System (ADVOS) device were included in this study
Summary
Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Frequency of multiple organ failure (MOF) is significantly increasing in critically ill patients within the last decades with a prevalence of more than 30% [1]. Liver failure is present in 20% of the ICU patients [1]. Acute kidney injury (AKI) occurs in > 50% of critically ill patients [3] and is more common in association with various forms of liver disease [4,5,6]. Respiratory failure is present in up to 30 percent of patients with acute liver failure during their stay at the ICU [9, 10]
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