Effect Of Continuous Veno-venous Hemofiltration Research Articles

Clinical effects of continuous veno-venous hemofiltration combined with hemoperfusion for the treatment of multiple myeloma complicated with acute kidney injury.

To evaluate the clinical efficacy of continuous veno-venous hemofiltration (CVVH) combined with hemoperfusion for the treatment of multiple myeloma (MM) complicated with acute kidney injury (AKI). Medical records of 73 patients with MM complicated with AKI admitted to the First People's Hospital of Huzhou from January 2019 to January 2021 were retrospectively analyzed. According to the treatment records, 35 patients received simple chemotherapy (control group), and 38 patients received CVVH combined with HP on the basis of chemotherapy (observation group). We compared the clinical efficacies, renal function indexes, and the serum globulin and erythrocyte sedimentation rate (ESR) values between the two groups. After the treatment, the total efficacy of the observation group was significantly higher (81.58%) than that in the control group (57.14%; p <0.05). Serum cystatin C (CysC), urea nitrogen (BUN), β2 macroglobulin (β2-MG) and creatinine (SCr) levels were significantly lower in the observation group than in the control group (p <0.05). Serum globulin level and ESR values in the observation group after the treatment were also significantly lower than in the control group (p <0.05). The outcomes of patients with MM complicated with AKI treated with CVVH and hemoperfusion differ significantly from those of the patients treated only with CVVH. Combining CVVH and hemoperfusion helps to improve the efficacy of the treatment, promotes renal function recovery, and improves the levels of serum globulin and ESR.

Calcium Chloride Requirement and Postreperfusion Rebound During Massive Transfusion in Liver Transplantation

The administration of citrated blood products during massive transfusion requires calcium salt administration to prevent citrate toxicity and to maintain ionized calcium values. The literature does not provide adequate guidance for the amount of calcium required during massive transfusions during liver transplantation. This study was conducted to provide guidance on calcium salt replacement during a massive transfusion in liver transplant patients, with a focus on the phase of transplantation during which citrate metabolism was minimal. An observational retrospective chart review. An academic single-institution study of hospitalized patients. One hundred thirty-two patients after liver transplantation. The study authors observed documented measurements of ionized calcium and observed the ratio of calcium salts to citrated bank blood products in patients undergoing liver transplantation with complete data sets. They also observed the effect of continuous venovenous hemofiltration on the distribution of ionized calcium values. Prereperfusion, an average of 1.09 g CaCl2/L of citrated blood was administered to maintain ionized calcium in the normal range. Postreperfusion, less CaCl2 was administered, and a rebound of ionized calcium occurred. Prereperfusion, continuous venovenous hemofiltration reduced the number of ionized calcium values outside of 2 standard deviations, meaning fewer values were critically low. With massive transfusions up to 67 liters (approximately 13 blood volumes), 1.09 g CaCl2/L citrated blood maintained ionized calcium in the normal range in the absence of citrate metabolism. This ratio may have value in empiric treatment when ionized calcium measurements are unavailable, and massive transfusion rates exceed metabolic capacity.

Antibiotics Removal by Continuous Venovenous Hemofiltration with a Novel Asymmetric Triacetate Membrane Hemofilter: An in vitro Study

Introduction: Continuous renal replacement therapies (CRRTs) are essential in the treatment of critically ill patients with acute kidney injury and are also discussed as a supporting sepsis therapy. CRRT can affect antibiotics plasma concentrations. Objective: The effect of continuous venovenous hemofiltration (CVVH) with an asymmetric triacetate (ATA) membrane hemofilter on concentrations of antibiotics with low (meropenem), medium (vancomycin), and high (daptomycin) protein binding (PB) was investigated. Methods: 1 L human whole blood supplemented with antibiotics was recirculated and filtrated for 6 h in vitro. Clearances and sieving coefficients (SC) were determined from antibiotics concentrations measured at filter inlet, outlet, and filtrate side. Reservoir concentration data were fitted using a first-order kinetic model. Results: Meropenem and vancomycin concentrations decreased to 5–10% of the initial plasma level, while only 50% of daptomycin were removed. Clearances and SCs were (10.8 [10.8–17.4] mL/min, SC = 0.72 [0.72–1.16]) for meropenem, (13.4 [12.3–13.7] mL/min, 0.89 [0.82–0.92]) for vancomycin, and (2.1 [1.8–2.1] mL/min, 0.14 [0.12–0.14]) for daptomycin. Removal by adsorption was negligible. Conclusions: The clearances and SCs presented are comparable with findings of other authors. Meropenem and vancomycin, which exhibit low and medium PB, respectively, were strongly removed, while considerably less daptomycin was removed because of its high PB. Our results suggest that in clinical use of the tested antibiotics during CRRT with the ATA hemofilter, the same factors have to be considered for determining the dosing strategy as with filters with other commonly applied membrane materials.

Effects of continuous venovenous hemofiltration on vancomycin trough concentrations in critically ill children.

BackgroundVancomycin trough concentrations are associated with clinical outcomes and drug adverse effects. This study investigates the effects of continuous venovenous hemofiltration (CVVH) on vancomycin trough concentrations in critically ill children with a vancomycin dosage of 40–60 mg/kg/day.MethodsChildren with steady-state vancomycin trough concentrations admitted to the pediatric intensive care unit (PICU) between January 2016 and December 2019 were retrospectively enrolled. Patients were divided into CVVH and non-CVVH groups according to treatment differences and renal function. Vancomycin trough concentrations were then compared between the groups, and risk factors for supratherapeutic trough concentrations (>20 mg/L) were analyzed with logistic regression.ResultsOf the 119 patients included, 35 were enrolled in the CVVH group and 84 in the non-CVVH group. Median vancomycin trough concentrations were significantly higher in the CVVH group than those in the non-CVVH group [14.9 (IQR =9.6–19.6) vs. 9.3 (IQR =7.0–13.4), P<0.001] and the proportion of therapeutic trough concentrations (10–20 mg/L) was similar between CVVH and non-CVVH groups (54.3% vs. 39.3%, P=0.133). However, CVVH therapy patients had a significantly higher proportion of supratherapeutic trough concentrations (20.0% vs. 1.2%, P=0.001) compared to the non-CVVH group. Multivariate analysis demonstrated that the Pediatric Risk of Mortality (PRISM) III score ≥28 (OR =13.7; 95% CI, 1.4–137.0; P=0.026] was an independent risk factor for supratherapeutic trough concentrations in critically ill patients.ConclusionsCVVH therapy affects vancomycin trough concentrations and is associated with supratherapeutic concentrations with a 40–60 mg/kg/day vancomycin dosage. PRISM III scores ≥28 may serve as an independent risk factor for supratherapeutic trough concentrations in children receiving CVVH therapy.

Continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia: A retrospective study of 13 cases.

This study aimed to evaluate the clinical effects of continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia. A total of 13 severely burned patients with acute hypernatremia admitted to Xijing Hospital were included in this study. All patients received continuous veno-venous hemofiltration treatment in addition to conventional treatment. The original sodium level in the replacement fluid was set to be lower than the serum sodium level by 8 mmol/L and subsequently undergoes a reduction rate of 2.16 ± 0.18 mmol/L every 4 h. Patients' clinical features, serum laboratory tests, hemodynamic variables, changes in sodium levels in serum, and replacement fluid during continuous veno-venous hemofiltration treatment were monitored. Patients had an average total burn surface area of 66.69% ± 20.28%. Two patients died of systematic Pseudomonas aeruginosa infections, and 11 patients survived. After continuous veno-venous hemofiltration treatment, patients showed a significant reduction in the serum sodium level (168.91 ± 4.88 mmol/L vs 144.62 ± 2.98 mmol/L, p < 0.01). Likewise, the serum levels of urea and creatinine decreased from 24.8 ± 6.5 mmol/L to 14.9 ± 8.3 mmol/L and from 278.6 ± 155.3 μmol/L to 152.6 ± 29.7 μmol/L, respectively (p < 0.05). The patients also displayed improvements in the Acute Physiology and Chronic Health Evaluation II and Glasgow scores (p < 0.05) and showed a significant reduction in hemoglobin and serum albumin levels (p < 0.05), but no obvious change in levels of platelets, alanine aminotransferase, and aspartate aminotransferase (p > 0.05). Our results indicate that continuous veno-venous hemofiltration with gradient sodium replacement fluid is effective in treating hypernatremia in severely burned patients with the controllable sodium reduction rate and satisfactory clinical outcomes.

OR05: Effect of Continuous Veno-Venous Hemofiltration on Measurement of Resting Energy Expenditure by Indirect Calorimetry. Results from the Meccias Trial

OR05: Effect of Continuous Veno-Venous Hemofiltration on Measurement of Resting Energy Expenditure by Indirect Calorimetry. Results from the Meccias Trial

The effect of continuous venovenous hemofiltration on neutrophil gelatinase-associated lipocalin plasma levels in patients with septic acute kidney injury.

BackgroundIt is known that continuous venonenous hemofiltration (CVVH) does not affect the plasma level of neutrophil gelatinase-associated lipocalin (pNGAL) in acute kidney injury (AKI) patients. However, because of the unique pathophysiology underlying AKI caused by sepsis, the effect of CVVH on pNGAL in this clinical setting is less certain. The purpose of this study was to determine the effect of CVVH on pNGAL in sepsis-induced AKI patients.MethodsBetween August 1, 2014, and December 31, 2014, 42 patients with sepsis-induced AKI underwent CVVH in the general intensive care unit of our institution and were consecutively enrolled in this study. Prefilter, postfilter, and ultrafiltrate pNGAL measurements were taken at the initiation of continuous renal replacement therapy (CRRT) and repeated after 2, 4, 8, and 12 h (T0, T2h, T4h, T8h, and T12h, respectively). The mass transfer, plasma clearance, and sieving coefficient were calculated based on the mass conservation principle.ResultsFollowing CVVH initiation, we found that pNGAL in the ultrafiltrate decreased significantly (P = 0.013); however, levels at the inlet and outlet showed no significant change (P > 0.05 for both). Furthermore, there was no change in the total mass removal rate, total mass adsorption rate, and plasma clearance over time (P > 0.05 for all), and a significant decrease in the sieving coefficient (P = 0.007) was seen.ConclusionsThe results of this study show a limited effect of CVVH on pNGAL in sepsis-induced AKI patients. This suggests that pNGAL may be used as an indicator of renal progression in these patients. However, a larger study to confirm these findings is needed.Trial registrationClinicalTrials.gov, NCT02536027. Retrospectively registered on 20th August 2015.

High cut-off hemofiltration versus standard hemofiltration: effect on plasma cytokines.

To study the effects of continuous veno-venous hemofiltration (CVVH) with high cut-off filters (CVVH-HCO) on plasma cytokine levels, sieving coefficient and clearance compared to CVVH using standard filters (CVVH-Std) in a nested cohort within a double-blind randomized controlled trial in severe acute kidney injury (AKI) patients. We measured plasma and post-filter levels of IL-6, TNF-alpha, IL-8, IL-1 beta, RANTES, IL-10, IFN-gamma and IFN-alpha in both study groups. We also measured cytokine levels in the ultrafiltrate and calculated sieving coefficients and clearances. By 72 hours of treatment, IL-6 had decreased during both treatments (p = 0.009 and 0.005 respectively). In contrast, IL-10 had decreased with CVVH-Std (p = 0.03) but not CVVH-HCO (p = 0.135). None of the other cytokines showed changes over time. There were also no significant between group differences in plasma levels for each cytokine over the 72-hour treatment period. For all cytokines combined, however, the median sieving coefficient was higher for CVVH-HCO (0.31 vs. 0.16; p = 0.042) as was the mass removal rate by ultrafiltration (p = 0.027). While overall combined cytokine levels had fallen to 62.2% of baseline at 72 hours for CVVH-HCO (p&lt;0.0001) and to 75.9% of baseline with CVVH-Std (p = 0.008) there were no between group differences. CVVH-HCO achieved greater combined sieving coefficient and mass removal rate by ultrafiltration for a group of key cytokines than CVVH-Std. However, this effect did not differentially lower their plasma level over the first 72 hours. Our study does not support the use of CVVH-HCO to lower cytokines in critically ill patients with AKI.

Putative novel mediators of acute kidney injury in critically ill patients: handling by continuous venovenous hemofiltration and effect of anticoagulation modalities

BackgroundNovel putative mediators of acute kidney injury (AKI) include immune-cell derived tumour necrosis factor-like weak inducer of apoptosis (TWEAK), angiopoietin-2 (Ang-2) and protein pentraxin-3 (PTX3). The effect of continuous venovenous hemofiltration (CVVH) and different anticoagulation regimens on plasma levels were studied.MethodsAt 0, 10, 60, 180 and 720 min of CVVH, samples were collected from pre- and postfilter blood and ultrafiltrate. No anticoagulation (n = 13), unfractionated heparin (n = 8) or trisodium citrate (n = 21) were compared.ResultsConcentrations of TWEAK, Ang-2 and PTX3 were hardly affected by CVVH since the mediators were not (TWEAK, PTX3) or hardly (Ang-2) detectable in ultrafiltrate, indicating negligible clearance by the filter in spite of molecular sizes (TWEAK, PTX3) at or below the cutoff of the membrane. Heparin use, however, was associated with an increase in in- and outlet plasma TWEAK.ConclusionNovel AKI mediators are not cleared nor produced by CVVH. However, heparin anticoagulation increased TWEAK levels in patient’s plasma whereas citrate did not, favouring the latter as anticoagulant in CVVH for AKI.

Continuous veno-venous hemofiltration in patients with metformin associated lactic acidosis

Metformin is frequently used by type II diabetics. A rare complication of its use is metformin associated lactic acidosis (MALA). This condition is often accompanied by extreme metabolic acidosis and hemodynamic instability for which ICU treatment is mandatory. Guidelines advice intermittent hemodialysis for correction of metabolic acidosis and to clear metformin. However, haemodynamic instability may prefer continuous veno-venous hemofiltration (CVVH). We evaluated the effect of CVVH in critically ill patients admitted with MALA.

Metabolism of albumin after continuous venovenous hemofiltration in patients with systemic inflammatory response syndrome.

Background. The systemic inflammatory response syndrome (SIRS) is characterized by a hypercatabolic state induced by inflammatory mediators. Continuous venovenous hemofiltration (CVVH) stabilizes the internal environment but also aggravates loss of amino acids. The effect of CVVH on protein dynamics is largely unknown. We adopted the stable isotopic tracer technology to investigate how CVVH changed serum albumin metabolism. Methods. Twenty SIRS patients were randomized into low- (2000 mL/h) and high- (4000 mL/h) volume CVVH groups according to the rate of replacement fluid. Eight patients with abdominal infection matched for age, sex, and laboratory index served as controls. Consecutive arterial blood samples were drawn during a primed-constant infusion of two stable isotopes to determine the albumin fractional synthesis rate (FSR) and fractional breakdown rate (FBR). Results. Before treatment, there was no significant difference of FSR and FBR among 3 groups. After CVVH, the albumin FSR in high- and low-volume groups was 7.75 ± 1.08% and 7.30 ± 0.89%, respectively, both higher than in the control (5.83 ± 0.94%). There was no significant difference in albumin FBR after treatment. Conclusions. Protein dynamic indicators could reflect protein synthesis and breakdown state directly and effectively. CVVH increased albumin synthesis, while the breakdown rate remained at a high level independently of the CVVH rate.

Effects of continuous veno-venous hemofiltration on albumin metabolism of patients with systemic inflammatory response syndrome

Objective To investigate the effects of continuous veno-venous hemofiltration (CVVH) on albumin metabolism of patients with systemic inflammatory response syndrome (SIRS).Methods The clinical data of 28 patients who were admitted to the Nanjing General Hospital of Nanjing Military Command from December 2010 to Decemer 2011 were retrospectively analyzed.All the patients were divided into the control group (8 patients),the low-volume CVVH group (2 000 ml/h,10 patients),and the high-volume CVVH group (4 000 mL/h,10 patients).Two stable isotopes,[1-13C] phenylalanine and d5-phenylalanine,were simultaneously intravenously infused into all the patients.The peak areas were calculated for segments with the mass to charge ratios of 192,194,197,218,219 by the selected ion mode of the gas chromatography mass spectrometry.The fractional synthesis rate (FSR) and the fractional breakdown rate (FBR) of albumin were calculated by the mathematical model.All data were analyzed using the one-way analysis of variance,LSD test or Dunnett's T3 test.Results The FSRs of albumin were 5.8％±0.9％,5.7％ ± 1.1％ and 5.7％ ± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.04,P＞0.05).The FSRs of albumin were 5.9％±0.8％,7.3％±0.9％ and 7.8％± 1.1％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment,with significant difference between the 3 groups (F =9.15,P ＜0.05).The FSRs of albumin of the low-volume CVVH group and the highvolume CVVH group were significantly higher than that of the control group (t =3.40,3.96,P ＜ 0.05),while no significant difference was detected between the low-volume CVVH group and the high-volume CVVH group in the FSR of albumin (t =1.02,P ＞ 0.05).The FBRs of albumin were 7.0％ ± 1.2％,6.5％ ± 0.9％ and 7.2％ ±1.2％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.88,P ＞ 0.05).The FBRs of albumin were 6.9％ ± 1.1％,6.2％±0.9％ and 7.4％± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment.There was no significant difference in the FBR of albumin after treatment between the 3 groups (F =2.82,P ＞ 0.05).Conclusions Simultaneous infusion of multiple isotopes for the detection of FSR and FBR of albumin is effective and feasible to detect the albumin metabolism.CVVH regulates the albumin metabolism in SIRS patients,and it can increase FSR of albumin in SIRS patients,while the FBR of albumin cannot be decreased by CVVH. Key words: Systemic inflammatory response syndrome; Stable isotope; Albumin; Continuous veno-venous hemofiltration

Continuous veno-venous hemofiltration and intermittent hemofiltration in treatment of type 1 cardiorenal syndrome: a clinical research

Objective To compare the effects of continuous veno-venous hemofiltration(CVVH)and intermittent hemofiltration(IHF) on the hemodynamics and clinical outcomes of patients with type 1 cardiorenal syndrome.Methods From May 2008 to June 2011,34 patients diagnosed with type 1 cardiorenal syndrome were admitted to our hospital and received CVVH(19 cases) or IHF(15 cases).The general data,acute hemodynamic changes before and after hemofiltration and clinical outcomes at 28 days after hemofiltration were evaluated.Results There were no significant differences in the heart rates,diastolic blood pressure between the two groups before and after hemofiltration(P0.05).The systolic pressure was similar between the two groups before hemofiltration(P0.05),but that in the IHF group was significantly lower than that in the CVVH group after hemofiltration(P0.05).No significant difference was found in the maximal mean pressure or blood pressure changes between the two groups at 48 h after hemofiltration(P0.05),but the minimal mean pressure in IHF group was significantly lower than that in the CVVH group(P0.05).The improvement of cardiac function and the mortality rates at 28 d after hemofiltration were not significantly different between the two groups(P0.05).Multivariate analysis suggested that APACHE Ⅱ was the main influence factor of 28-day mortality of patients,and APACHE Ⅱ and net ultrafiltration were the main influence factor of the minimal mean pressure.Conclusion Compared with IHF,CVVH fails to greatly reduce the mortality of patients with type 1 cardiorenal syndrome.The severity of the disease is the main influence factor for the hemodynamic changes and the 28-day mortality of patients with type 1 cardiorenal syndrome.

Molecular Biomarkers: Tools of Medicine

Molecular Biomarkers: Tools of Medicine

Immunomodulatory Effect of Continuous Venovenous Hemofiltration during Sepsis: Preliminary Data

Introduction. Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many pro- and anti-inflammatory mediators, such as interleukin-6 (IL-6), play a strategic role in septic syndrome. Continuous renal replacement therapy (CRRT) removes in a nonselective way pro- and anti-inflammatory mediators. Objective. To investigate the effects of continuous venovenous hemofiltration (CVVH) as an immunomodulatory treatment of sepsis in a prospective clinical study. Methods. High flux hemofiltration (Qf = 60 ml/Kg/hr) was performed for 72 hr in thirteen critically ill patients suffering from severe sepsis or septic shock with acute renal failure (ARF). IL-6 gene expression was measured by real-time PCR analysis on RNA extracted from peripheral blood mononuclear cell before beginning of treatment (T0) and after 12, 24, 48, and 72 hours (T1–4). Results. Real-time PCR analysis demonstrated in twelve patients IL-6 mRNA reduction after 12 hours of treatment and a progressive increase after 24, 48, and 72 hours. Conclusions. We suggest that an immunomodulatory effect might exist during CVVH performed in critically ill patients with severe sepsis and septic shock. Our data show that the transcriptional activity of IL-6 increases during CVVH.

Effect of continuous veno-venous hemofiltration on the peripheral blood levels of high mobility group box chromosomal protein 1 in patients with systemic inflammatory response syndrome or sepsis

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on the peripheral blood levels of high mobility group box chromosomal protein 1 (HMGB-1) in patients with systemic inflammatory response syndrome (SIRS) or sepsis.Methods Thirty patients with SIRS or sepsis in Intensive Care Unit of our hospital were scheduled for treatment of CVVH.The replacement liquid was put in by the pattern of pre-dilution of 40％ and post-dilution of 60％.The flow-rate was 3 L/h.The blood flow-rate was from 200 to 300 ml/min.5 ml blood from right radial artery was got at the time points of preCVVH,CVVH 2 h,6 h,8 h and post-CVVH 12 h and the serum was stored at the temperature of-20 ℃ after high speed centrifugation,and 2 ml filter liquor was reserved at the time point of CVVH 6 h.The concentration of serum and filter liquor HMGB-1 was measured by ELISA,but that of TNF-α and IL-6 were measured by radioimmunity.Results 30 patients adept CVVH therapy within 24 h to the hospital,and their therapy time was 2 ～ 5(2.4 ± 1.5) d.Among them,17 cases survived and 13 cases died with a fatality rate of 43.3％.Serum concentration of HMGB-1 decreased from the baseline in patients,although this decrease was not statistically significant[(11.88 ± 6.06) ng/ml,(11.97 ± 5.66) ng/ml,(11.94 ± 5.94) ng/ml,(11.73 ± 5.19) ng/ml vs (13.87 ± 4.68) ng/ml,P ＞ 0.05],Serum concentration of both TNF-αand IL-6 after therapy significantly decreased compared to the baseline in patients [TNF-α: (0.28 ± 0.15)ng/ml,(0.30 ± 0.14) ng/ml,(0.29 ± 0.19) ng/ml,(0.33 ± 0.19) ng/ml vs (0.41 ± 0.12) ng/ml,IL-6:(408.20 ±92.18)pg/ml,(250.51 ± 107.34)pg/ml,(276.00 ± 126.20) pg/ml,(315.16 ± 130.97) pg/ml vs (513.35 ± 125.95) pg/ml,P ＜ 0.05].Conclusions CVVH could decrease the concentration of HMGB-1 in peripheral blood,which would be one of the mechanisms of action for CVVH on sepsis. Key words: Systemic inflammatory response syndrome/therapy; Sepsis/therapy; High mobility group proteins/blood; Hemofiltration

Effects of continuons blood purification on patients with severe acute pancreatitis

Objective To explore the therapeutic effect of continuous veno-venous hemofiltration (CVVH) on the treatment of severe acute pancreatitis (SAP).Methods All data about forty-five patients with SAP admitted to the intensive care unit (ICU) from June 2005 through June 2010 were reviewed.These 45 patients were randomly (random number ) divided into routine treatment group (n =22 ) and comprehensive treatment group ( n =23 ).In control group,patients were rapidly given with a suffficient liquid support,vasoactive drug to increase organ perfusion,trypsin secretion inhibitor,broad-spectrum antibiotics,enteral nutrition with intestine membrane protective agent in early stage.In the comprehensive treatment group,patients received CVVH integrated with routine treatment.On admission and 72 h posttreatment,the scores of acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) and multiple organ dysfunction syndrome (MODS),and the results of standard bettery of biochemistry tests indcluding blood urea nitrogen (BUN),serum cratinine (Scr),total bilirubin (TBIL),alanine aminotransferase (ALT),amylase (AMS),C-reactive protein (CRP),TNF-α,IL-6,IL-8 were observed.Time of mechanical ventilation support,length of ICU stay,and survival rate were compared between two groups.Results On admission between the two groups,no statistical significance was seen in the APACHE Ⅱ and MODS score,BUN,Scr,TBIL,ALT,AMS,CRP,TNF-α,IL-6,IL-8 (P ＞ 0.05).But APACHE Ⅱ and MODS score were decreased significantly in comprehensive treatment group than in the routine treatment group,as well as the the level of BUN,Scr,TBIL,ALT,AMS,TNF-α,IL-6,IL-8 and CRP after 72h post-treatment (P＜0.05 ).In routine treatment group and comprehensive treatment group,the time of respirator intervention and length of stay in ICU were (7.6±3.4) d vs.(11.5±4.7) d,(12.3±7.8) dvs.(17.6±9.2) d respectively,the statistical significance was shown ( P ＜ 0.05 ).Compared to the comprehensive treatment group ( 86.96％ ),the survival rate ( 59.09％ ) were lower in routine treatment group ( P ＜ 0.05 ).Conclusions CVVH combined with routine treatment,which can remove inflammatory agents and toxins,maintain homoeostasis,and improve oxygenation,is effective in treatment of SAP and can improve patient survival rate. Key words: Continuous veno-venous hemofiltration; Continuous blood purification; Severe acute pancreatitis; Systemic inflammatory response syndrome (SIRS); Multiple organ dysfunction syndrome (MODS) ; Abdominal compartment syndrome (ACS); Treatment; Evaluation

Effects of Continuous Venous-Venous Hemofiltration on Heat Stroke Patients: A Retrospective Study

Heat stroke (HS) is a fatal illness characterized by an elevated core body temperature above 40°C and complicated with rhabdomyolysis and acute renal failure. We retrospectively analyzed the effect of continuous veno-venous hemofiltration (CVVH) in patients with HS. A total of 16 patients with HS were retrospectively analyzed. All patients were treated by CVVH for at least 96 hours, and CVVH was initiated with replacement fluid between 25°C and 30°C for 2 hours to 2.5 hours, and 36°C thereafter. The vital signs were monitored and blood samples were collected during CVVH to measure serum urea, creatinine, myoglobin, creatine kinase, and total bilirubin. All patients survived. The core temperature of the patients decreased from 41.3 ± 0.2°C to 38.7 ± 0.1°C after 2 hours and to 36.7 ± 0.1°C after 5 hours during CVVH (p < 0.05). Compared with values before starting CVVH, there were remarkable improvements in mean arterial blood pressure, heart rate, and oxygenation index (p < 0.05). The serum creatinine, urea, myoglobin, and creatine kinase decreased significantly (p < 0.05), while the bilirubinemia had no obvious decline (p > 0.05). The scores of APACHE II and arterial lactate had also obvious decline (p < 0.05). The hemodynamic variables were stabilized during CVVH, and no obvious side effects related to CVVH were found. CVVH is safe and feasible in the treatment of patients with HS by lowering core temperature, removal of myoglobin, support of multiorgan function, and modulating systemic inflammatory response syndrome (SIRS). The impact of CVVH on patient outcome, however, still needs proof by larger randomized controlled trials.

Therapeutic value of continuous veno-venous hemofiltration administration in treating fulminant myocarditis

ObjectiveTo evaluate the therapeutic effects of continuous veno-venous hemofiltration (CVVH) in treating fulminant myocarditis (FM).Methods and resultsWe retrospectively analysed 8 cases of FM patients in our institution from March 2009...

Supratherapeutic oseltamivir levels during continuous dialysis: an expected risk

Dear Editor, We read with interest the recent correspondence by Lemaitre and colleagues. The authors describe the case of a patient treated with highdose oseltamivir (150 mg BID) for severe infection due to influenza A/H1N1. Despite receiving simultaneous extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemodiafiltration (CVVHDF), oseltamivir carboxylate (OC) Cmax and AUC0–12 were fivefold higher in comparison to data from healthy volunteers [1]. We offer a possible explanation for their findings. After oral administration, oseltamivir phosphate (an inactive prodrug) is rapidly converted to OC, the active metabolite. OC is primarily (60–70%) eliminated renally as unchanged drug through a combination of glomerular filtration and tubular secretion. The mean total renal clearance of OC in healthy volunteers is 18.8 L/h. This vastly exceeds glomerular filtration rate (*125 ml/min = 7.5 L/h), which suggests a significant degree of clearance via tubular secretion. Indeed, tubular secretion of OC occurs via the anionic transport process and inhibition of secretion by probenecid results in an approximate twofold increase in Cmax, 2.5-fold increase in AUC, and a 50% decrease in renal clearance [2]. OC is readily dialyzable through continuous renal replacement therapy (CRRT). The effects of continuous veno-venous hemofiltration (CVVHF) on the clearance of OC were investigated in an in vitro study. The authors found a minimal amount of adsorption to the hemofilters (*1%) and a sieving coefficient of *1 [3]. This would suggest that clearance during hemodiafiltration should approximate the sum of dialysate and ultrafiltrate flow rates [4]. In the case by Lemaitre and colleagues, the patient was initiated on CVVHDF with flow rates of 1.5 L/h dialysate and 1.5 L/h ultrafiltration. We assume that there was minimal tubular secretion of drug since the patient was anuric. Therefore, the maximum extracorporeal clearance rate generated by CVVHDF would be 3 L/h. Although Lemaitre and colleagues point out that adhesion of drugs to the ECMO circuit may occur, it is unlikely that this would significantly contribute to the overall drug clearance [5]. Given the above data, the clearance of OC in this patient would be expected to be *6 times lower than that in healthy volunteers (3 L/h vs. 18.8 L/h), which is in line with their findings. Oseltamivir is well-tolerated to doses up to 1,000 mg, with the main adverse effect being transient gastrointestinal upset [2]. Understandably, many clinicians prefer to dose oseltamivir aggressively when treating critically ill patients with influenza (especially that due to H1N1). Given the paucity of data, it is difficult to make firm dosing recommendations at this time. However, investigators and clinicians should be aware that supratherapeutic levels should be expected when high-dose oseltamivir is given to patients receiving CRRT.