Continuous Renal Replacement Therapy (CRRT) indication is still discussed. We report our experience on 98 patients affected with Multiple Organ System Failure (MOSF) and renal failure (acute or chronic) requiring dialysis and timely treated by CRRT. Mortality after 5 days of ICU permanence was 60.2%; the remaining 39 patients were discharged within 21 days and received CRRT treatment for 6.36 +/- 5.59 days. APACHE II score was not able to predict the outcome of patients suffering from acute renal failure (ARF). On the contrary, Systemic Inflammatory Response Syndrome (SIRS) incidence was significantly higher in deceased patients compared to recovered patients. In conclusion, it is important to start dialytic treatment immediately when patients affected with MOSF show renal function damage, even if at an initial stage, in order to improve patients' survival. Moreover a multidisciplinary approach is preferable in ICU patients treatment for not underestimating the management of metabolic and infective complications, the nursing care, and nutritional support.
Hemoperfusion has been used in the treatment of mushroom poisoning for many years. The aim of this study was to study the efficacy of charcoal plasmaperfusion (CPP) and continuous renal replacement therapy (CRRT) in 2 patients severely poisoned by the amanita mushroom. Both patients arrived at the ICU from another hospital with a diagnosis of amanita phalloides mushroom poisoning. The patients were precociously treated with CRRT for 20 h and CPP for 3 h every day. The treatments were effected for 3 and 5 days, respectively. Both patients recovered completely and were discharged asyntomatic after 7 and 10 days.
An increase in solute removal, a shorter dialysis session, the patient's well being and the reduction of global costs are the principal aims of the new hemodialysis methods. The simultaneous use of two hemodialyzers in hemodialysis has been experimented by other researchers. Our technique involves the use of two cuprophan hemodialyzers in sequence (double filter system: DFS), each one connected separately to fresh dialysate. Fifteen symptomatic large patients were treated with DFS and the results were compared to conventional hemodialysis (CHD). After the first hemodialyzer, modification of pH and electrolytes occurred in the plasma composition. In the second hemodialyzer, urea depuration occurred without further significant changes in hydroelectrolytic or acid-basic plasma patterns. The Kt/V increased from 1.10 to 1.29 (18%). The authors conclude that in DFS there was an advantage in urea clearance, osmolarity stability and reduction of side effects.
Background/Aims: The principal aims of the new hemodialysis methods are: a short-time dialysis session, the increase of solute removal, the patient’s well-being and, when possible, the reduction of global costs. Other researchers have experimented the simultaneous use of two hemodialyzers in hemodialysis. We tested a new technique which involves the use of two Cuprophan hemodialyzers in sequence (double filter system: DFS), each one connected separately to fresh dialysate. Methods: We treated 15 large patients with DFS and compared the results with conventional hemodialysis (CHD). Results: Our results showed a significant difference between CHD and DFS in the depuration values. After the first hemodialyzer, modification of pH and electrolytes occurred in the plasma composition. In the second hemodialyzer, urea depuration occured without further significant changes in hydroelectrolytic and acid-basic plasma patterns. The Kt/V increased from 1.10 to 1.29 (18%). Conclusion: Our technique is conceived for the following goal: to increase the diffusion of solution without increasing costs and side effects.
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