Super high-flux CVVHD using regional citrate anticoagulation: long-term stability of middle molecule clearance

M Siebeck,D Kindgen-Milles

doi:10.1186/cc14381

Abstract

Conventional membranes used for CRRT have a limited middle molecule clearance. New membranes called super high-flux (SHF) or high cutoff membranes have been investigated. The loss of albumin with hemofiltration is a major drawback, but these membranes can be used in CVVHD with regional citrate anticoagulation (Ci-Ca® CVVHD), which may limit albumin loss, and contribute to a prolonged filter patency and an improved and stable middle molecule clearance. We evaluated saturation coefficients (SC), plasma clearances (PCL) and serum levels of eight small and middle molecules during 72 hours of Ci-Ca® CVVHD with a SHF membrane (Ultraflux®EMiC®2).

Highlights

To assess cerebral hemodynamics in an experimental sepsis model
Since the Surviving Sepsis Campaign (SSC) in 2002, the Health Service Ombudsman for England published recommendations for improving recognition and treatment of sepsis [2], the Royal College of Physicians issued a toolkit for the management of sepsis in the acute medical unit [3], and NHS England released a patient safety alert to support prompt recognition and treatment of sepsis [4]
We sought to estimate the number of unalerted sepsis episodes to assess the efficacy of our screening tool and improve early recognition

Summary

Introduction

We evaluated platelet activation markers as potential predictive markers of sepsis and of mortality among four commonly encountered populations of patients admitted to ICUs. Methods Ninety-nine non-infected ICU patients were prospectively screened at day 1 (T1) and day 3 (T2) of admission after elective cardiac surgery, trauma, acute neurologic dysfunction or prolonged ventilation (>48 hours). The present study was performed with the aim of assessing whether nursing and physician staff were able to identify patients in need of critical care using only clinical judgment and to compare this with the National Early Warning Score (NEWS) Methods This was a prospective cohort study of all adult patients with a first-time admission to a medical admission unit at a 450-bed regional teaching hospital over a 3-month period in 2010.

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