Extracorporeal Blood Purification Methods Research Articles

ACUTE BLOOD PURIFICATION METHODS IN INTENSIVE CARE OF COMPLICATIONS AFTER CARDIAC SURGERY.

<h3>Objective</h3> Complications after cardiac surgery have serious negative consequences, prolonging intensive care (ICU) stay days and significantly increasing costs. Prevention and treatment of complications after cardiac surgery is a serious problem. According to numerous authors, the incidence of complications after cardiac surgery varies from 10 to 60%. The most common and prognostically significant complications are bleeding, acute kidney injury and infection. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery, however, still extremely high among patients with complications. Impaired renal function, or active infectious process, sepsis has significant prognostic consequences which are the cause of up to 40% of deaths. As a solution may serve various methods of blood purification. In recent decades, the blood purification method of choice in the therapy of numerous pathological conditions is resistant to traditional therapy. This study details one centre's experience of acute blood purification application in the ICU. <h3>Materials and Methods</h3> Structural analysis of acute extracorporeal blood purification methods application to patients in ICU. The period from 2015 to the 2021 year. <h3>Results and Discussion</h3> For the period from 2015 to 2021 more than a thousand patients underwent extracorporeal methods of blood purification due to complications after cardiac surgery or the severity of the condition. Throughout the period effectiveness and safety were assessed. Blood purification is an option of therapy for numerous complications in the postoperative period(acute kidney injury, Systemic inflammatory response reaction syndrome, sepsis cytokine storm, fluid overload). We have a positive experience with extracorporeal blood purification application to patients after different types of cardiac surgery (open valve surgery, surgery of myocardium revascularization, implantation of left ventricular assist device, heart and lungs transplantation, transcatheter manipulation) in the immediate postoperative period. The structure of procedures and patients' characteristics are shown in table 1. <h3>Conclusion</h3> Acute extracorporeal blood purification methods are a significant option in therapy of complications after cardiac surgery. Procedures are effective and safe. This direction requires further development and study.

MO353: Extracorporeal Blood Purification of Complications After Aortic Valve Replacement. Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement

Abstract BACKGROUND AND AIMS Complications after cardiac surgery have serious negative consequences, prolonging the average ICU stay days and costs. Prevention and treatment of complications after aortic valve replacement is a serious problem. According to numerous authors, the incidence of complications after aortic valve replacement varies from 10 to &amp;gt;60% of cases. Development of complications is associated with a higher hospital mortality rate, the risk of infection and a more complex course of the disease. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery; however, it can still exceed 40% among those patients who develop a postoperative complication and can reach 50% in patients requiring extracorporeal blood purification therapy. Impaired renal function or active infectious process has significant prognostic consequences, which are the cause of up to 40% of deaths. The aim of this work is to structure or compare complications in immediate postoperative period after aortic valve replacement by the surgical and transcatheter method. METHOD Retrospective analysis of 267 medical records. All patients in study were after aortic valve replacement, hospitalized in JSC NSCC Nur-Sultan, Kazakhstan, from 1 January 2020 to 31 October 2021. A total of 127 patients SAVR, 137 patients TAVR. Of those, 3 patients were excluded from the study due to chronic haemodialysis. Inclusion criteria: informed consent to participate in research. Age is&amp;gt;18 years old. Prosthetics of the aortic valve by the SAVR or TAVR methods. Treatment of postoperative complications by the extracorporeal blood purification methods. Exclusion criteria: refusal to participate in research. Age is &amp;lt;18 years old. Chronic dialysis. Active bleeding. The patients were divided into two groups: group 1—patients after aortic valve replacement by the TAVR method and group 2—patients after open surgery aortic valve—SAVR. Indications for extracorporeal blood purification methods: acute kidney injury (AKI), acute liver injury, the systemic inflammatory response syndrome (SIRS) and cytokine storm. RESULTS Period from 2020 to 2021. TAVR group—137 patients, male―65 (47.45%), female—72 (52.55%), the average age of patients was 69.2±11.16 years. In the SAVR group, there were 127 patients, of which male 43 (33.9%) and female 84 (66.1%), the average age was 47.04 ± 13.67 years. CONCLUSION Complications and mortality rate are more common after open surgery SAVR than after TAVR. Extracorporeal blood purification methods are required after an open valve replacement. Extracorporeal blood purification methods are an effective way to treat complications such as AKI and SIRS after aortic valve replacement.

MO373EXPERIENCE OF EXTRACORPOREAL BLOOD PURIFICATION METHODS APPLICATION TO PATIENTS WITH SEVERE COVID - 19

Background and AimsIn the rapidly changing conditions of life due to the COVID - 19 pandemic, the medical society around the world have faced with the question of treatment previously unknown, multi-faceted and insidious infection. The coronavirus infection has forced doctors to reconsider the tactics of intensive care patients in critical condition. To date, overall mortality rate from COVID – 19 varied from 8.11 to 120.85 per 100.000 population (Johns Hopkins University mortality analyses). Mortality rate in extremely severe cases exceeds 60% - 78% (Yang et al., Lancet Respiratory Medicine, 2020. Zhou et al., Lancet, 2020).We would like to share our clinical experience of extracorporeal blood purification methods application to patients in ICU with various clinical manifestations, as well as the presence of comorbid pathology.MethodWe conducted a retrospective analysis of 239 medical records of patients hospitalized in the ICU of JSC NRCSC Nur-Sultan, Kazakhstan because of severe course of COVID 19. Period of hospitalization from 16.06.2020 to 29.09.2020, the total number of beds - 97, in the ICU - 25.ResultsThe total number of patients with COVID -19 - 239 patients. In ICU -67 patients. Patients required in renal replacement therapy (RRT) – 31 patients.Among patients on RRT males-28 (90.3%) - female-3 (9.67%).Mean age-60 years.Distribution of the comorbid pathology.NOComorbid pathologyN = 31Diabetes insipidus10 (32,2%)Sepsis5 (16.1%)MODS6 (19.3%)Acute kidney damage 2 (KDIGO 2018)9 (29%)Acute kidney damage 3 (KDIGO 2018)5 (16.1%)Anuria11 (35.48%)Acute respiratory failure 324 (77.4%)ARDS19 (61.29%)Artificial lung ventilation28 (90.32%)COPD3 (9.67%)Hypertension9 (29%)Ischemic heart disease6 (19.3%)Obesity9 (29%)Cytokine storm19 (61.29%)ECMO15 (48.38%)LVAD1 (3.22%)Gastric ulcer1 (3.22%)Indications for RRT: acute respiratory failure in the absence of heart failure or fluid overload; presence of diffuse alveolar damage (DAD) (detected by high-resolution CT); PaO2 / FiO2 ≤ 300 mm Hg Duration:> 6-24 hours per column with a blood flow rate of 80-120 ml/min. In addition, indications for the urgent start of extracorporeal treatment are:signs of severe coronavirus infection (respiratory rate ≥ 30 per minute and / or blood oxygen saturation ≤ 93% and / or PO2/FiO2 index ≤ 200 mmHg;detection of lung lesion progression using one of the imaging methods ≥10% per day;progressive increase in the level of inflammatory markers (CRP, IL-6, etc.).The duration of hospitalization in the ICU – 12.54 days.Combinations and duration of the procedures.Name of the procedure(n)Duration (in hour)HP HA330 + CVVHF/CVVHDF 2+1+1 (n=33)> 1224 чHP Cytosorb© + CVVHF/CVVHDF 1+1+1(n=5)> 24 чHP HA330II+ CVVHF/CVVHDF 2+1+1 (n=31)> 1224 чPE + CVVHF/CVVHDF 2+1+1(n=7)> 624 чHP2+1+1(n=14)> 3-6 чFootnote: combinations and duration of use are in accordance with the recommendations of Ronco C. et al. (2020).Laboratory data - Leukocyte, CRP, Interleukine, procalcitonin, Creatinin, presepsin in dynamics.Laboratory dataBefore blood purificationAfter the 1st procedureAfter the 2nd procedureAfter the 3d procedurep valueLeukocyte15.3013.3110.688.230.01CRP17.9116.1214.1013.020.02Il - 6260.77205.82201.188188.90.027PCT26.5812.134.345.560.01Creat2.331.771.891.340.01Presepsin2420.242788.811783.562063.410.18General Mortality – 37 from 239 (15.5%)Mortality in ICU – 37 from 67 (55.2%)According to literature review, the mortality rate of patients with severe COVID - 19 in the ICU (Fawad Rahim et al, Cureus . 2020 Oct 12;12(10):e10906. doi: 10.7759/cureus.10906.) without the use of CRRT exceeds 70-77%.)ConclusionOur analysis had showed a positive effect of early use (1 day of hospitalization) of extracorporeal methods of blood purification, on a decreasing of inflammation indicators, as well as positive survival rate of patients with severe COVID-19 course in ICU conditions.

Extracorporeal Strategies in Sepsis Treatment: Role of Therapeutic Plasma Exchange

Mortality in sepsis remains high. Various techniques for extracorporeal cytokine removal have been investigated as additional therapeutic measures in sepsis and septic shock. To summarize a selection of extracorporeal blood purification techniques, with a special focus on therapeutic plasma exchange, and their current evidence in clinical use. Non-systematic literature review. Various extracorporeal blood purification techniques with different levels of evidence regarding cytokine removal, vasopressor sparing effects and reduction of mortality are currently in clinical use. Most extensively studied modalities include high-volume hemofiltration/dialysis with and without high cut-off filters a well as hemoadsorption techniques (including CytoSorb, and polymyxin-B filters). Despite partly encouraging observations regarding removal of inflammatory cytokines and hemodynamic stabilization, results from randomized studies did not show an effect on survival. Due to use of donor plasma as substitution fluid, therapeutic plasma exchange represents the only modality able to additionally replace protective and consumed factors. The use of extracorporeal blood purification methods cannot be recommended for sepsis patients outside of clinical trials given the current lack of evidence of their efficacy. Future investigations should aim to homogenize the studied patient collective in respect to clinical sepsis severity, time point of intervention and different inflammatory (sub-)phenotypes.

ЭКСТРАКОРПОРАЛЬНОЕ ОЧИЩЕНИЕ КРОВИ В ИНТЕНСИВНОЙ ТЕРАПИИ ОСТРОЙ ПЕЧЕНОЧНОЙ НЕДОСТАТОЧНОСТИ

Intensive therapy of acute liver failure includes the use of hepatoprotectors, intracorporeal detoxification, correction of coagulopathy and encephalopathy and in the case of a fulminant form - liver transplantation. Extracorporeal blood purification methods are used in most cases of treatment of this pathology. However, the choice of a particular method, as well as the timing of its application remains the subject of discussion. The analysis of 46 literature sources was carried out with the aim of studying modern approaches to the use of extracorporeal blood purification methods in acute liver failure.

P0642EFFECTIVENESS OF HEMADSORPTION IN REDUCING FREE LIGHT CHAINS IN PATIENTS WITH MULTIPLE MYELOMA A.M.FOMIN, A.V.VATAZIN MOSCOW REGIONAL RESEARCH AND CLINICAL INSTITUTE. MOSCOW, RUSSIAN FEDERATION

Abstract Background and Aims Acute kidney injury is a frequent complication of multiple myeloma with unfavorable prognostic significance. The aim of the present study is to evaluate the effectiveness of hemadsorption to reducing free light chains (FLCs) in patients with multiple myeloma without replacement kidney therapy. Method The research was conducted for 6 patients ages 65- 74 with multiple myeloma. All patients were already suffering from a mild degree of renal insufficiency and elevated free light chains (4 kappa, 2 lambda). All patients didn’t have renal replacement therapy. Patients received VMP induction chemotherapy after two sessions of hemadsorption. The level of creatinine was from 198 µmol/l to 289 µmol/l. The glomerular filtration rate (eGFR) was from 34,8 to 21,3 mL/min/1,73 m2. The level of kappa FLC was 1714 – 5600 mg/L. The level of lambda FLC was 1575 – 3220 mg/L. In CytoSorb therapy, the blood is purified by adsorption in a procedure similar to hemoperfusion. The hemadsorption procedures were carried out on the AK10 device (Gambro, Sweden) with use of CytoSorb adsorbent cartridge. The content of the CytoSorb cartridge consists of a highly porous high-tech polymer. The patients were treated with 2 CytoSorb hemoadsorption treatments for 10 hours each separated and from one another by a pause interval of 12-14 hours. The blood flow rate was 130-160 ml/min. Anticoagulation was ensured by washing the bloodlines and a cartridge with a sorbent with normal saline with heparin – 4,000 units of activity per 1 L. 5,000 units of activity of heparin were injected intravenously at the beginning of the procedure. The FLCs, the level of creatinine and coagulogram test results of patients were studied prior to procedure and upon termination of procedure. Results An extracorporeal blood purification methods reduce elevated levels of FLCs. The cartridge with a total surface of&amp;gt;40,000 square meters, an adsorber is able to effectively and over time lower hydrophobic (water-insoluble) molecules that can be removed up to a size of 55kDa. FLC have high molecular weight (monomeric kappa of 22.5 kDa, dimeric lambda of 45 kDa). FLC removal, combined with chemotherapy may be associated with renal function recovery. As a result of hemadsorption after carrying out two procedures, there was a significant decrease in level kappa FLCs by 78.3 %, lambda FLCs by 64,0 %. All patients were dialysis independent. The level of creatinine decreased and the glomerular filtration rate increased. Other blood chemistry parameters did not show any changes. Throughout the treatment, the study did not show a decrease in dynamics of hemoglobin or platelets. There were not negative dynamics in change of INR (international normalized ratio), APTT (activated partial thromboplastin time), level of fibrinogen, prothrombin, or anti-thrombin III. No bleeding complication occurred in any patient during the procedure of hemadsorption. Other biochemical values did not change significantly. Conclusion The research showed that an extracorporeal blood purification method by CytoSorb therapy reduce elevated levels of FLCs in patients with multiple myeloma. The benefits of this modality need confirmation with a randomized controlled trial.

Dynamics of essential amino acids plasma levels in patients with sepsis treated by the extracorporeal blood purification methods

Extracorporeal blood purification (EBP) is one of the trends of effective sepsis therapy. Some disadvantages of this method such as a possible reduction of plasma levels of different important metabolites are described. It is known that sepsis disorders of amino acid metabolism are manifested in microcirculation interruptions, the decreased immune response and the increased mortality. The aim of the study is to investigate the EBP effect on the essential amino acid plasma levels in patients diagnosed with sepsis. We selected 38 patients diagnosed with sepsis. Standard treatment protocols of plasma filtration, hemofiltration, and hemadsorption with various sorbents were used. We revealed a significant decrease in the levels of valine, methionine, tryptophan, isoleucine, phenylalanine, leucine, and lysine in patients who underwent hemadsorption by the sorbent “Proteasosorb”. Hemadsorption by the sorbent “Proteasosorb” has the greatest effect on the levels of amino acids.

Peritoneal Dialysis in Acute Kidney Injury: Lessons Learned and Applied

Peritoneal dialysis (PD) is a simple, safe, gentle, and efficient renal replacement therapy (RRT) method. It is able to correct acute kidney injury (AKI)-induced metabolic, electrolytic, and acid-base disorders and volume overload both in and out the intensive care unit setting. Some PD modalities, such as high-volume PD and continuous flow PD, can provide RRT doses and efficiency comparable to extracorporeal blood purification methods. PD is particularly suitable for children, patients with refractory heart failure or hemodynamically instable, conditions where systemic anticoagulation should be avoided, patients with difficulty for vascular access and hypo- and hyperthermia conditions. In the following manuscript, PD technical aspects and the possible advantages and limitations of this RRT method will be discussed, and the more recent literature on clinical experience with PD for treatment of AKI will be reviewed.

Plasmapheresis for neurological disorders

Apheresis is a general term that describes removal of abnormal blood constituents by extracorporeal blood purification methods. To date, therapeutic plasma exchange (PE) is the most common apheresis procedure. Here, plasma is separated from corpuscular blood constituents and replaced with a substitution fluid. In contrast to immunoadsorption, PE is a nonspecific treatment modality with elimination of the entire plasma. The therapeutic effect is based on the removal of circulating, pathogenic immune factors including autoantibodies. Currently, PE is used for treatment of several immune-mediated neurological disorders. While first experiences relate to acute life-threatening conditions, such as treatment of Guillain–Barré syndrome or myasthenic crisis, therapeutic success was also shown in chronic diseases where immunosuppressive therapy is often required for long-term management. PE has been applied successfully in chronic inflammatory demyelinating polyneuropathy, paraproteinemic polyneuropathy, stiff person syndrome, and may also be tried in several diseases of paraneoplastic origin. In recent years, PE was also established as an escalation therapy for steroid-unresponsive relapses of multiple sclerosis, and thus has gained more widespread attention. Adding to its increasing application in clinical practice, the procedure is usually well tolerated. Possible adverse reactions mainly relate to vascular access, the use of replacement fluids and the need for anticoagulation.

Membranes in artificial organs.

Membrane processes by a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extra-corporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.