Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Villa, Gianluca; Neri, Mauro; Bellomo, Rinaldo; Cerdá, Jorge; Gaudio, Angelo Raffaele De; Rosa, Silvia De; Garzotto, Francesco; Honoré, Patrick M.; Kellum, John A.; Lorenzin, Anna; Payen, Didier; Ricci, Zaccaria; Samoni, Sara; Vincent, Jean‐Louis; Wendon, Julia; Zaccaria, Marta; Ronco, Claudio

doi:10.1186/s13054-016-1456-5

Cited by 106 publications

(89 citation statements)

References 44 publications

(40 reference statements)

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“…Although further developments and improvements are planned for the years to come and some of new technologies have not reached their full clinical potential; yet, these new devices are already modifying the scenario of applied technology to critically ill patients. In addition to safety features of the therapy, other aspects have become important in further developments including smooth treatment performance, easy usability, and consequent efficient use of resources, application of a standardized nomenclature [16][17][18], and possibly, a biofeedback-controlled treatment using signals from patients and machines to drive treatment parameters. In literature, there is already some idea of how these devices will evolve from today to the next 10 years [19].…”

Section: Discussionmentioning

confidence: 99%

ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study)

et al. 2019

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Background: ACUsmart (Medica S.P.A., Italy) is a new-generation, continuous renal replacement therapy (CRRT) machine for critically ill patients with acute kidney injury. We designed a multicenter international pilot study to provide a description of outlines of the ACUsmart system, evaluation aspects of functionality, usability, and feasibility, discriminating reasons of possible treatment’s withdrawals or discontinuations and highlighting strong and weak points of the machine. Methods: Data of 23 CRRT (and 11 plasma exchange) treatments were collected from 4 intensive care units. Parameters such as treatment duration, downtime, delivered dose, and number and type of alarms were recorded. The general perception of the machine was quantified through the administration of a survey to each component of the evaluating staff. Results: A total treatment time of 447 h was carried with ACUsmart. Eleven continuous veno-venous hemofiltration, 4 continuous veno-venous hemodialysis , and 8 continuous veno-venous hemodiafiltration were performed. The average percentage of net treatment duration with respect to total treatment duration was 92.37%. The mean prescribed dose and delivered dose were 26.33 and 24.10 mL/kg/h, respectively. In general, the machine was rated by users involved as practical and easy to use, although few components need to be slightly improved. Conclusion: ACUsmart is a new multifunctional machine that meets most of the features required in a fourth-generation CRRT equipment.

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Section: Discussionmentioning

confidence: 99%

ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study)

et al. 2019

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“…Nevertheless, the avoidance of anticoagulation accelerates membrane fouling during CRRT, leading to membrane clotting [20]. Membrane fouling is a critical factor for a rapid decline of transmembrane clearance (particularly for large molecules), for discrepancies between the current dose and the current effective delivered dose and for premature interruption of the extracorporeal treatment [13, 21]. Thus, membrane fouling is particularly harmful in extracorporeal blood purification therapies, such as HCO-CVVHD, performed in septic AKI patients to remove large molecules (e.g., cytokines) [15].…”

Section: Discussionmentioning

confidence: 99%

Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study

et al. 2018

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Background: Convective therapies with high cut-off membranes (HCO) are usually not recommended because of theoretical excessive albumin loss. The aim of this in vitro study is to demonstrate the noninferior safety of pre-dilution hemodiafiltration with HCO (HCO-CVVHDF) with isotonic citrate anticoagulation (18 mmol/L) with respect to heparin anticoagulated hemodialysis with HCO (HCO-CVVHD) in terms of albumin removal and citrate load. Method: Albumin removal was compared in vitro between 3 pre-dilution-HCO-CVVHDF with citrate anticoagulation and 3 HCO-CVVHD with heparin anticoagulation during 30-min single-pass and 180-min recirculation phases. Results: Considering concentrations and flows in the extracorporeal circuit, the transmembrane albumin removal was 2.06 (1.51; 2.09) g and 2.09 (1.9; 2.8) g respectively for HCO-CVVHDF and HCO-CVVHD, during the single-pass phase; 2.8 (2.67; 4.59) g and 2.54 (2.35; 4.67) g, respectively, for HCO-CVVHDF and HCO-CVVHD during the recirculation phase. Based on the citrate saturation coefficients, a citrate metabolic load of 8.86 mmol/h has been calculated for HCO-CVVHDF. Conclusion: HCO-CVVHDF performed with regional anticoagulation with 18 mmol/L citrate solution does not induce higher albumin transmembrane removal compared to HCO-CVVHD.

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“…Recently the ADQI consensus group proposed to uniform and harmonize the scientific language concerning RRTs in critically ill patients [23][24][25] . Standardization of terminology is also quintessential for the optimal utilization of big data files and electronic medical records in future pragmatic trials [10] .…”

Section: The Ccn Teammentioning

confidence: 99%

Critical Care Nephrology: A Multidisciplinary Approach

Rizo-Topete

Ronco²

2016

Blood Purif

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Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists. A personalized patient management is strongly recommended as proposed by the recent criteria of precision medicine. Early identification of patients at risk and timely intervention in case of AKI diagnosis can be obtained by integrating the role of nephrologist in the ICU practice. An innovative model of organization by introducing the nephrology rapid response team is advocated to manage critically ill patients with kidney problems in order to make early diagnosis and interventions, to reduce progression toward CKD and improve renal recovery. The routine adoption of AKI biomarkers together with such a collegial teamwork may represent the pathway toward success.

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Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Cited by 106 publications

References 44 publications

ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study)

ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study)

Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study

Critical Care Nephrology: A Multidisciplinary Approach

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