Intensive Care Potentials of Continuous Arteriovenous Hemofiltration

Krämer, P.; Biege, G.

doi:10.1007/978-3-642-70370-6_28

Cited by 11 publications

(11 citation statements)

References 2 publications

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“…On such occasions, we usually perform addi tional sessions of intermittent hemofiltration. For this rea son, CAVHD has been introduced in our ICU in order to serve such type of ARF patients, being tempted by Geronemous and Schneider [4] results and those of Raja et al [18]. The outcome of CAVHD from this study (60%) is satis factory if we consider our previous results (55%) in a similar group of patients [17] and recent results from other centers [19,20] where the overall survival was 24 and 29%, respec tively.…”

Section: Discussionsupporting

confidence: 68%

“…Continuous arteriovenous hemodialysis (CAVHD) [3] has been introduced in our intensive care units (ICU) as an alternative to continuous arteriovenous hemofiltration (CAVH) [4] for the treatment of ARF during the last few years. This is because, from our experience, some patients Extracorporeal Circuit CAVHD was performed using polysulfone membranes (Amicon, Am D20, Am D30 and AM D30 high-performance filters) as dialysers.…”

Section: Introductionmentioning

confidence: 99%

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Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

Alarabi¹,

Danielson²,

Wíkström³

1993

Nephron

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The clinical outcome of continuous arteriovenous hemodialysis (CAVHD), an alternative to continuous arteriovenous hemofiltration (CAVH) in our intensive care units (ICU) in Uppsala, was evaluated for 2 years. Forty-three patients were included. Pretreatment serum urea and creatinine levels (mean ± SD) were 36 ± 13 mmol/land 420 ± 147 μmol/l and during treatment, steady-state levels were 25 ± 10 mmol/land 333 ± 120 μmol/l respectively (p < 0.0001). On top of acute renal failure (ARF), some patients had multiple organ failure that made it necessary to use mechanical respiration (63%), vasopressor drugs (74%) and aortic balloon pump therapy (5%). The outcome of this treatment was 60% when overall survival was considered. Higher dialysate flow rates (i.e., 25 ml/min) were applied in some patients in whom serum urea levels were persistently rising. The result of this was a notable decrease in the urea and creatinine serum levels. From the results of this 2-year experience, we have found CAVHD a promising alternative to CAVH that can be used as a treatment of choice for ARF in critically ill ICU patients.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

Alarabi¹,

Danielson²,

Wíkström³

1993

Nephron

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“…4,5). The linearity may be obscured if the data points are taken from different patients with large variations in Hct and plasma protein, since both parameters have profound effects on QB and QF at a given MAP [10,18). For instance, QF decreases with increasing plasma pro tein at a given MAP, and conversely, a patient with higher MAP and higher plasma protein may have the same QF as a patient with lower MAP and lower plasma protein.…”

Section: Discussionmentioning

confidence: 99%

Continuous Arteriovenous Hemof iltration: In vivo Functional Characteristics and Its Dependence on Vascular Access and Filter Design

Olbricht

Haubitz

Häbel

et al. 1990

Nephron

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The in vivo functional characteristics of continuous arteriovenous hemofiltration (CAVH) were studied in 21 intensive-care patients with acute renal failure. FH-66 hemofilters were applied. The relationships between prefilter blood pressure (BP), blood flow (QB) and filtration rate (QF) were evaluated by stepwise clamping of the arterial access and simultaneous measurements of these parameters. The correlations between BP and QB, and between QB and QF, were linear (p < 0.001). The total pressure drop across the extracorporeal circuit was 90 ± 12 mmHg with Scribner shunt and 70 ± 13 mmHg with femoral catheters as vascular access. The relative pressure drops across arterial access, hemofilter and venous access for Scribner shunt and for femoral catheter were 30%, 43% and 27% and 12%, 74% and 14%, respectively. At a given BP, QB was lower and transmembrane filtration pressure (TMP) higher in CAVH with Scribner shunt. QB was 102 ± 38 ml/min; QF was 20 ± 7 ml/min. The effects of hemofilter geometry and membrane material on functional parameters of CAVH were evaluated by applying four hemofilters (Amicon D-20 HP, D-30 HP, Gambro FH-66, Fresenius AV-400) consecutively in the same patient. The filters were different with respect to hollow fiber length, its internal diameter, number of fibers and membrane material. BP, hematocrit (Hct) and plasma protein remained constant during measurements. QB increased with decreasing filter resistance. QF did not increase with increasing QB. QF was also not closely related to membrane surface area. The hydraulic permeability (Lp) had a major impact on QF. The Lp of the polysulfone membranes was between 47 and 35% lower than that of polyamide membranes. Hence, at given values of TMP and surface area, polyamide filters may have a higher QF. Filtration pressure dysequilibrium was always present irrespective of filter geometry, membrane material, BP, Hct and plasma protein.

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“…However, overly aggressive ultrafiltration in patients with decompensated heart failure can convert nonoliguric renal dysfunction into oliguric renal failure by increasing neurohormonal activation and decreasing renal perfusion pressure, with minimal opportunity of recovery of renal function. Published reports suggest that complication rates are acceptable [32][33][34]. Using a large-bore catheter inserted into the femoral artery and the patients' own blood pressure, arterial blood is delivered to a hemofilter.…”

Section: Rationale For the Use Of Ultrafiltration In Heart Failurementioning

confidence: 99%

The role of ultrafiltration in the management of heart failure

Costanzo

2006

Curr Treat Options Cardio Med

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In the United States, 90% of one million annual hospitalizations for heart failure are due to symptoms of volume overload. Hypervolemia contributes to heart failure progression and mortality. Treatment guidelines recommend that therapy for patients with heart failure be aimed at achieving euvolemia. Intravenous loop diuretics induce a rapid diuresis that reduces lung congestion and dyspnea. However, loop diuretics' effectiveness declines with repeated exposure. Unresolved congestion may contribute to high re-hospitalization rates. Furthermore, loop diuretics may be associated with increased morbidity and mortality due to deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration is an alternative method of sodium and water removal, which safely improves hemodynamics in patients with heart failure. Application of this technology has been limited by the need for high flow rates, large extracorporeal blood volumes, and large-bore central venous catheters. A modified ultrafiltration device has overcome these limitations. Ultrafiltration may be a safe and effective alternative to intravenous diuretics in the treatment of decompensated heart failure.

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Intensive Care Potentials of Continuous Arteriovenous Hemofiltration

Cited by 11 publications

References 2 publications

Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

Continuous Arteriovenous Hemof iltration: In vivo Functional Characteristics and Its Dependence on Vascular Access and Filter Design

The role of ultrafiltration in the management of heart failure

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