Multiple-Organ Extracorporeal Support Therapies in Critically Ill Patients

José Lucas Daza,Luis Daza,Yaroslad De La Cruz,John Galindo,Jonathan De Jong,Luis Puello,Gerardo Gutiérrez,María C Correcha Ferro,Emilio Rey,Andrés David Cardenas

doi:10.4236/ojneph.2021.112023

Abstract

The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO2, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus®) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.

Highlights

Ill patients are known to be at risk of developing organ dysfunction during their stay within the intensive care unit, when this dysfunction compromises three or more organs this mortality can reach up to 90% [1]
The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious as well as non-infectious, this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option
Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF)

Summary

Introduction

Ill patients are known to be at risk of developing organ dysfunction during their stay within the intensive care unit, when this dysfunction compromises three or more organs this mortality can reach up to 90% [1]. Secondary MODS: organ dysfunction that is not a direct response to aggression itself, but a consequence of a host-regulated response (e.g. acute respiratory distress syndrome presenting in a patient with pancreatitis) [2]. Deterioration of an organ’s function is often followed by dysfunction or damage to other organs resulting in negative interactions with different systems [3] an example of this is the cardiorenal syndrome, hepatorenal syndrome, alterations within the cardiopulmonary circulation, which become a vicious cycle with deleterious consequences. Cardiac dysfunction resulting in cardiorenal syndrome, alterations of the cardiopulmonary circulation, acute respiratory distress syndrome, the intestine and kidney can present reciprocal negative interactions and due to primary alterations within the host’s intestinal microbiota and a disturbance of the intestinal barrier’s function which leads to systemic inflammation [12]

Extracorporeal Therapies

Hemoperfusion

Plasmapheresis

OBJECTIVE

Findings

Conclusions