Continuous Venous Hemofiltration Research Articles

A case of acute copper sulphate poisoning and literature review

Objective: To analyze the clinical data of acute copper sulphate poisoning, and discuss the timing and prognosis of the treatment. Methods: The clinical data of a case of acute copper sulphate poisoning treated in Yantaishan Hospital in May 2020 were analyzed, and CNKI, Weipu database and Wanfang database were retrieved with "copper sulfate""poisoning" and "blood purification" as search terms respectively. Such as "copper sulphate/cupric sulfate""poisoning" and "blood purification " were respectively tested in the PubMed database and reviewed the literatures. Results: The patient was admitted to hospital due to "oral copper pentahydrate for 14 h". Plasma exchange and continuous venous hemofiltration were performed on the 2nd day of poisoning, and the liver enzymes and creatinine indexes were normal. The patient recovered and left the hospital after 10 days. After literature retrieval, 13 literatures were screened out, a total of 14 cases were reported. All recovered after blood purification, copper displacement and liver protection. Conclusion: When acute copper sulphate poisoning occurs with multiple organ function damage mainly caused by hemolysis and kidney injury, the treatment with blood purification has a good prognosis while removing copper and organ support.

Determination of Citrate Clearance Used in Regional Anticoagulation of Continuous Venous Hemofiltration Circuits

Determination of Citrate Clearance Used in Regional Anticoagulation of Continuous Venous Hemofiltration Circuits

Clinical effect of haemoperfusion combined with continuous veno-veno haemofiltration in treatment of paraquat poisoning: a Meta-analysis

To systematically analyze the effect of haemoperfusion (HP) combined with continuous veno-veno haemofiltration (CVVH) in the treatment of the patients with paraquat poisoning (PQP). Words of paraquat, poisoning, continuous venous hemofiltration, hemoperfusion, hemodiafiltration in Chinese and paraquat, poisoning, intoxication, haemofiltration, continuous venovenous haemofiltration, haemoperfusion in English were chosen as keywords, the Chinese and English literatures about acute PQP treated with HP combined with CVVH published in Wanfang database, CNKI, CBM, VIP database, PubMed, Embase, Cochrane Library were searched by computer, and the retrieval time was from the establishment of the database to July 2018. The experimental group was treated with HP combined with CVVH, while the control group was treated with HP alone. Besides, the outcome indicators included mortality, survival time of dead patients (the patient's time from exposure to poison to death), serum creatinine (SCr), alanine aminotransferase (ALT), arterial partial pressure of oxygen (PaO2), and incidence of circulatory and respiratory failure. The literature data were extracted by two researchers independently, the quality of the literature was evaluated according to the modified Jadad score table or Newcastle-Ottawa scale (NOS), and the Meta-analysis was carried out by RevMan 5.3 software; and the stability of the results of Meta-analysis was tested by sensitivity analysis. Further, the publication bias was analyzed through drawing a funnel diagram. Finally, 20 articles were included, with 18 in Chinese and 2 in English. Among them, 6 were randomized controlled trial (RCT) and 14 were case-control studies. Furthermore, a total of 2 870 patients were involved, with 1 558 in the control group and 1 312 in the experimental group. Meta-analysis showed that the mortality rate of patients in the experimental group was significantly lower than that in the control group [odds ratio (OR) = 0.55, 95% confidence interval (95%CI) = 0.42 to 0.73, P < 0.000 1], the patients' time from toxin exposure to death was significantly longer than that in the control group [standard mean difference (SMD) = 2.16, 95%CI = 1.46 to 2.86, P < 0.000 01). In the course of treatment, the peak value of SCr in the experimental group was significantly lower than that in the control group (SMD = -0.53, 95%CI = -0.65 to -0.42, P < 0.000 01), and the peak value of ALT was also decreased (SMD = -0.72, 95%CI = -0.99 to -0.44, P < 0.000 01). Besides, there was no significant difference in PaO2 between the two groups on the 3rd day of treatment (SMD = 0.15, 95%CI = -0.19-0.49, P = 0.40), but on the 7th day, PaO2 in the experimental group was significantly higher than that in the control group (SMD = 0.23, 95%CI = 0.29 to 0.98, P = 0.000 3). Furthermore, the incidence of circulatory failure in the experimental group was significantly lower than that in the control group (OR = 0.26, 95%CI = 0.19 to 0.37, P < 0.000 01), but the incidence of respiratory failure was significantly higher than that in the control group (OR = 4.14, 95%CI = 3.00 to 5.72, P < 0.000 01). The influence of heterogeneity on statistical results was excluded in the sensitivity analysis, and funnel plot diagram was applied to indicate the publication bias of mortality and survival time of the dead patients. Combined with HP alone, HP combined with CVVH could better improve liver and kidney function and oxygenation state of PQP patients, reduce the incidence of early circulatory failure, prolong the survival time and reduce the death rate of PQP patients.

The effects of continuous blood purification in patients with septic shock during perioperative period

Objective To evaluate the effects of continuous blood purification in patients with septic shock during perioperative period. Methods Forty-seven patients with infectious shock during perioperative period were enrolled and randomly divided into experimental group(group D, n=23) and control group(group F, n=24). Patients in group D received continuous venous hemofiltration starting before surgery till 72 hours after surgery. Patients in group F were treated with blood purification for 72 hours postoperatively. The blood oxygenation index, pH, HCO, base excess(BE), BUN, serum creatinine(SCr), SBP, DBP and HR were recorded in the two groups before surgery (T0), by the end of operation (T1), and 24 h (T2), and 48 h (T3), and 72 h (T4) after operation. The duration of operation, the perioperative doses of dopamine and metaraminol, and the recovery rate of patients were recorded, as well. Results Doses of dopamine and alamin in group D were significantly lower than those in group F (P 0.05), there was significant difference in oxygenation index at T2-T4 (P 0.05). There were no significant difference in biochemical indexes between group F and group D at T0 (P>0.05). Conclusions Continuous blood purification for perioperative patients with septic shock improved patients′ outcome: stabilizing homeostasis, maintaining the hemodynamics, reducing the doses of vasoactive drugs, improving patients′ tolerance and recovery rate. Key words: Perioperative period; Septic shock; Continuous blood purification

An Intriguing Tale of a Patient Passing Copious Amounts of Watery Stools

Introduction:C. difficile is one of the commonly diagnosed infectious causes of acute diarrhea in hospital settings. Other non-infectious causes of acute diarrhea often get overlooked especially when a diagnosis as common as C. difficile colitis has been made. Case Report: 78-year-old male with a history of HTN, hyperlipidemia, lung cancer s/p resection and metastatic gastric cancer (on chemotherapy) was transferred to our tertiary medical center for ICU care. He carried a diagnosis of first episode of fulminant C. difficile colitis and was suspected of harboring a hyper virulent strain at the outside facility. The patient had already finished 10 days of metronidazole therapy but still had high volume watery diarrhea with more than 20 bowel movements a day. This led to progressive dehydration, acute kidney injury and hemodynamic instability needing pressor support and Continuous venous hemofiltration (CVVH) for first few days in our ICU. Stool studies were redone besides other metabolic work-up. Abdominal imaging showed mildly dilated bowel loops. Oral vancomycin was added to his regimen besides aggressive IV hydration and supportive management. In spite of optimal medical support, the diarrhea persisted with clinical deterioration. We rescrutinized his recent medications to discover that he had finished recently his second cycle of chemotherapy (epirubicin, oxaliplatin and capecitabine) around three weeks ago for management of gastric cancer. The patient revealed further that he had milder self limiting episode of watery diarrhea after the first cycle of chemotherapy also. Keeping a possibility of chemotherapy induced diarrhea, we added octeotride to his regimen to achieve a rapid and gratifying response over next few days. The patient was finally transitioned to oral loperamide and discharged to home with complete remission of his diarrhea symptoms. Discussion: Chemotherapy-induced diarrhea (CID) has been described in cancer management with fluoropyrimidines (like 5-fluorouracil), capecitabine and irinotecan. The proposed mechanism of CID is direct toxicity to rapidly dividing crypt cells of the intestinal epithelium, and the destruction and/or augmentation of intestinal enzymes. This disrupts the balance between absorptive and secretory capacity, and alters the osmotic gradients in the gut, thereby leading to increased secretion of fluids and electrolytes in the stool. Despite the life threatening severity of CID, it is often under-recognized, as was the case in our patient.

Application and nursing of bedside continuous venous hemofiltration in ICU

床旁连续静静脉血液滤过(continuous venovenous hemofiltration,CVVH)是连续血液净化(continuous blood purification,CBP)技术的一种.将CBP用于非肾脏的危重症救治尚属新疗法[1].2002年4～8月,我院ICU应用CVVH救治危重症病人18例,效果显著,现报告如下。