Abstract
During the last 7 years in our ICU, CVVH was used as renal support in 101 critically adults (79 M, 22 F, median age 57, range 17–86) with acute renal failure (ARF). Patients who were treated with CVVH for less than 24 hours were excluded from this report. APACHE score at admission was 23 (median, range 8–42). The majority of the patients was on mechanical ventilation (98%) and needed vasopressor support (91%). Vascular access was performed with the use of a blood pump. Conventional heparin was used for anticoagulation in the most of the cases (90%). In 31 of the patients (group A) CVVH was initiated upon their first day of admission while in the rest 70 pts (group B) CVVH was started on the 9th day, median (range 2–32) of their hospitalization in the ICU. Uremia was satisfactory controlled in most of the cases with a mean amount of ultrafiltrate of 38.7 ± 0.6 SEM, l/day (range 27–49.5). Patients of group A remained on CVVH treatment for a median of 5 days (range 1–40), while those of group B for 4.5 days (range 1–29), P = NS. Although serum creatinine levels at the initiation of CVVH did not show any difference between the groups (group A 4.9 ± 0.4 SEM, group B 5.2 ± 0.5 SEM, P = NS), the corresponding BUN level were lower in patients of group A (86.0 ± 7.1 SEM vs 112.8 ± 6.9 SEM, P = 0.021). The duration of hospitalization (days) in the ICU was also lower in the group A patients (10.7 ± 2.2 SEM vs 24.2 ± 2.0 SEM, P = 0.0001). Ten (10) patients of group A (32.2%) and 15 pts of group B (21.4%) were survived and discharged from the ICU, χ2 = NS, with a mean serum creatinine and BUN levels that did not differ between these two groups. The overall mortality was 75.2%. It is concluded that in the ICU the mortality rate of critically ill adults patients with ARF demanding renal support treatment remains high despite the use of CVVH and that the timing of ARF occurrence and CVVH initiation does not exert any major influence on the outcome of these patients.
Highlights
In our experience, very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient
The difference between both attributable mortality rates (22.1%) was statistically significant
P109 How we reduce allogenic blood transfusions in the patients undergoing surgery of ascending aorta D Radojevic, Z Jankovic, B Calija, M Jovic, B Djukanovic
Summary
Very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient. There is evidence that increasing the dose of continuous renal replacement therapy (CRRT) is associated with improved survival in critically ill patients with acute renal failure (ARF) [1]. The aim of this study is to investigate if there is any difference in patients’ characteristics in ICU between COPD and nonCOPD diseases caused chronic respiratory failure and require mechanical ventilation during acute exacerbations. Noninvasive positive pressure ventilation (NPPV) has been reported to be beneficial in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), and to facilitate weaning In this trial we assessed the possible benefit of early NPPV in patients with blunt chest trauma and acute respiratory failure. The aim of this study was to compare the pharmacokinetic and pharmacodynamic parameters and the clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in critically ill adults patients with gram negative bacilli infection. The purpose of the study is to identify the factors associated with DNR status in our institution
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