Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Abstract

How to cite this article: Yaroustovsky M, Abramyan M, Komardina E, Nazarova H. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus 2017;1:49-60.Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra-and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period. Key words:Extracorporeal blood purification, acute kidney injury, acute liver failure, extracorporeal membrane oxygenation, sepsis, selective lipopolysaccharideadsorption, critical condition, cardiovascular surgery ABSTRACT Article history:

Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series

“…For example, in Japan, there are three sizes of PMX column: PMX-20R, PMX-05R, and PMX-01R, with blood volumes 135, 40, and 8 mL, respectively. The PMX-05R was used to treat sepsis in 10 children 9–48 months old ( 19 ), and PMX-01R was used in preterm infants ( 20 , 21 ). There were no reports of treatment complications.…”

Blood conservation protocol based on modified ultrafiltration towards bloodless pediatric surgery

“…Cardiopulmonary Bypass (CPB) may cause severe hemodilution and an acute systemic infl ammatory response syndrome; hemodilution can leads to a dilutional coagulopathy with reduced levels of most hemostatic elements causing bleeding disorders and excessive perioperative blood loss. As systemic infl ammation response, the development of capillary fl uid leakage, causing protein and fl uids shift into interstitial space increasing total body water resulted in hypovolemia with the need for blood product transfusion [1][2][3] and increasing of the postoperative myocardial dysfunction and respiratory failure [4][5][6]. In the other side, there were accumulating evidence of the negative impact associated with Red Blood Cells (RBCs) transfusion on morbidity and mortality in the pediatric cardiac population, including infection risk, post-injury multiorgan failure, increased hospital and intensive care length of stay, and the costs [7][8][9][10].…”