The Experts below are selected from a list of 231 Experts worldwide ranked by ideXlab platform
Claudio Ronco - One of the best experts on this subject based on the ideXlab platform.
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Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report.
Blood Purification, 2019Co-Authors: Silvia De Rosa, Sara Samoni, Claudio RoncoAbstract:: We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay [EAA] 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin®, Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA
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Fluid balance and acute kidney injury
Nature Reviews Nephrology, 2010Co-Authors: John R. Prowle, Jorge E. Echeverri, E. Valentina Ligabo, Claudio Ronco, Rinaldo BellomoAbstract:Intravenous fluids are widely administered to patients who have, or are at risk of, acute kidney injury (AKI). However, deleterious consequences of overzealous fluid Therapy are increasingly being recognized. Salt and water overload can predispose to organ dysfunction, impaired wound healing and nosocomial infection, particularly in patients with AKI, in whom fluid challenges are frequent and excretion is impaired. In this Review article, we discuss how interstitial edema can further delay renal recovery and why conservative fluid strategies are now being advocated. Applying these strategies in critical illness is challenging. Although volume resuscitation is needed to restore cardiac output, it often leads to tissue edema, thereby contributing to ongoing organ dysfunction. Conservative strategies of fluid management mandate a switch towards neutral balance and then negative balance once hemodynamic stabilization is achieved. In patients with AKI, this strategy might require renal replacement Therapy to be given earlier than when more-liberal fluid management is used. However, hypovolemia and renal hypoperfusion can occur in patients with AKI if excessive fluid removal is pursued with diuretics or Extracorporeal Therapy. Thus, accurate assessment of fluid status and careful definition of targets are needed at all stages to improve clinical outcomes. A conservative strategy of fluid management was recently tested and found to be effective in a large, randomized, controlled trial in patients with acute lung injury. Similar randomized, controlled studies in patients with AKI now seem justified.
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Today’s Approach to the Critically Ill Patient with Acute Kidney Injury
Blood Purification, 2009Co-Authors: Zaccaria Ricci, Claudio RoncoAbstract:The present review describes recent evidence on all aspects relating to acute kidney injury (AKI): epidemiology, definition, diagnosis, medical and Extracorporeal Therapy. AKI is often underrecognized
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Renal replacement therapies: physiological review
Intensive Care Medicine, 2008Co-Authors: Claudio Ronco, Zaccaria RicciAbstract:IntroductionA physiological review on renal replacement therapies (RRT) is a challenging task: there is nothing "physiologic" about RRT, since the most accurate, safe and perfectly delivered Extracorporeal Therapy would still be far from "physiologically" replacing the function of the native kidney.MethodsThis review will address the issues of physiology of fluid and solute removal, acid base control and impact on mortality during intermittent and continuous therapies: different RRT modalities and relative prescriptions will provide different "physiological clinical effects" to critically ill patients with acute kidney injury (AKI), with the aim of restoring lost "renal homeostasis". On the other side, however, the "pathophysiology" of RRT, consists with unwanted clinical effects caused by the same treatments, generally under-recognized by current literature but often encountered in clinical practice. Physiology and pathophysiology of different RRT modalities have been reviewed.ConclusionPhysiology and pathophysiology of RRT often coexist during dialysis sessions. Improvement in renal recovery and survival from AKI will be achieved from optimization of Therapy and increased awareness of potential benefits and dangers deriving from different RRT modalities.
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Renal replacement therapies: physiological review.
Intensive Care Medicine, 2008Co-Authors: Claudio Ronco, Zaccaria RicciAbstract:Introduction A physiological review on renal replacement therapies (RRT) is a challenging task: there is nothing "physiologic" about RRT, since the most accurate, safe and perfectly delivered Extracorporeal Therapy would still be far from "physiologically" replacing the function of the native kidney.
Zaccaria Ricci - One of the best experts on this subject based on the ideXlab platform.
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Today’s Approach to the Critically Ill Patient with Acute Kidney Injury
Blood Purification, 2009Co-Authors: Zaccaria Ricci, Claudio RoncoAbstract:The present review describes recent evidence on all aspects relating to acute kidney injury (AKI): epidemiology, definition, diagnosis, medical and Extracorporeal Therapy. AKI is often underrecognized
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Renal replacement therapies: physiological review
Intensive Care Medicine, 2008Co-Authors: Claudio Ronco, Zaccaria RicciAbstract:IntroductionA physiological review on renal replacement therapies (RRT) is a challenging task: there is nothing "physiologic" about RRT, since the most accurate, safe and perfectly delivered Extracorporeal Therapy would still be far from "physiologically" replacing the function of the native kidney.MethodsThis review will address the issues of physiology of fluid and solute removal, acid base control and impact on mortality during intermittent and continuous therapies: different RRT modalities and relative prescriptions will provide different "physiological clinical effects" to critically ill patients with acute kidney injury (AKI), with the aim of restoring lost "renal homeostasis". On the other side, however, the "pathophysiology" of RRT, consists with unwanted clinical effects caused by the same treatments, generally under-recognized by current literature but often encountered in clinical practice. Physiology and pathophysiology of different RRT modalities have been reviewed.ConclusionPhysiology and pathophysiology of RRT often coexist during dialysis sessions. Improvement in renal recovery and survival from AKI will be achieved from optimization of Therapy and increased awareness of potential benefits and dangers deriving from different RRT modalities.
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Renal replacement therapies: physiological review.
Intensive Care Medicine, 2008Co-Authors: Claudio Ronco, Zaccaria RicciAbstract:Introduction A physiological review on renal replacement therapies (RRT) is a challenging task: there is nothing "physiologic" about RRT, since the most accurate, safe and perfectly delivered Extracorporeal Therapy would still be far from "physiologically" replacing the function of the native kidney.
Ayse Akcan-arikan - One of the best experts on this subject based on the ideXlab platform.
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Continuous Renal Replacement Therapy (CRRT) in Liver Failure and Other Liver Assist Devices
Critical Care Nephrology and Renal Replacement Therapy in Children, 2018Co-Authors: Bogdana Sabina Zoica, Ayse Akcan-arikan, Akash DeepAbstract:Liver failure, both acute (ALF) and acute-on-chronic liver failure (ACLF), present unique challenges in critical care, especially in children. Advances in medical technology and orthotopic liver transplantation (OLT) have improved overall survival in pediatric liver failure (LF). Blood purification in the form of combined Extracorporeal Therapy is often necessary to support the multiple organ failure associated with a failing liver either as a bridge to spontaneous regeneration or successful liver transplantation. Different therapies using Extracorporeal liver assist devices (ECLD) as well as challenges such as circuit anticoagulation will be discussed after a brief review of pathophysiology as context for Extracorporeal Therapy use in pediatric LF.
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Neonatal Extracorporeal renal replacement Therapy—a routine renal support modality?
Pediatric Nephrology, 2016Co-Authors: Joseph R. Angelo, Ayse Akcan-arikanAbstract:Peritoneal dialysis (PD) is generally considered the preferred Extracorporeal Therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement Therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.
Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.
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Fluid balance and acute kidney injury
Nature Reviews Nephrology, 2010Co-Authors: John R. Prowle, Jorge E. Echeverri, E. Valentina Ligabo, Claudio Ronco, Rinaldo BellomoAbstract:Intravenous fluids are widely administered to patients who have, or are at risk of, acute kidney injury (AKI). However, deleterious consequences of overzealous fluid Therapy are increasingly being recognized. Salt and water overload can predispose to organ dysfunction, impaired wound healing and nosocomial infection, particularly in patients with AKI, in whom fluid challenges are frequent and excretion is impaired. In this Review article, we discuss how interstitial edema can further delay renal recovery and why conservative fluid strategies are now being advocated. Applying these strategies in critical illness is challenging. Although volume resuscitation is needed to restore cardiac output, it often leads to tissue edema, thereby contributing to ongoing organ dysfunction. Conservative strategies of fluid management mandate a switch towards neutral balance and then negative balance once hemodynamic stabilization is achieved. In patients with AKI, this strategy might require renal replacement Therapy to be given earlier than when more-liberal fluid management is used. However, hypovolemia and renal hypoperfusion can occur in patients with AKI if excessive fluid removal is pursued with diuretics or Extracorporeal Therapy. Thus, accurate assessment of fluid status and careful definition of targets are needed at all stages to improve clinical outcomes. A conservative strategy of fluid management was recently tested and found to be effective in a large, randomized, controlled trial in patients with acute lung injury. Similar randomized, controlled studies in patients with AKI now seem justified.
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The future of Extracorporeal support.
Critical Care Medicine, 2008Co-Authors: Dinna N. Cruz, Rinaldo Bellomo, John A. Kellum, Claudio RoncoAbstract:Extracorporeal Therapy has expanded significantly over the past few decades from solely artificial renal replacement Therapy. In patients with multiple organ dysfunction syndrome, it becomes necessary to provide multiple organ support Therapy. Technological advances have opened the door to a multifa
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Complications of continuous renal replacement therapies
Critical Care Nephrology, 1998Co-Authors: Claudio Ronco, Rinaldo BellomoAbstract:Continuous renal replacement therapies (CRRT) are widely used as a treatment of acute renal failure (ARF) in critically ill patients. Due to the severe illness of these patients, it is sometimes difficult to distinguish between complications related to the Therapy and those related to the illness per se. However, due to its invasive nature, any Extracorporeal Therapy cannot be free of complications, and it should be carefully monitored [1].
W L Macias - One of the best experts on this subject based on the ideXlab platform.
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Extracorporeal Therapy requirements for patients with acute renal failure
Journal of The American Society of Nephrology, 1997Co-Authors: W L Macias, W R Clark, Bruce A Mueller, Michael A KrausAbstract:Renal replacement Therapy (RRT) requirements for critically ill patients with acute renal failure (ARF) depend on numerous factors, including the degree of hypercatabolism, patient size, and desired level of metabolic control. However, the current practice at many institutions is to prescribe generally similar amounts of RRT to ARF patients essentially without regard for the above factors. In this study, a computer-based model designed to permit individualized RRT prescription to ARF patients was developed. The critical input parameter is the desired level of metabolic control, which is the time-averaged BUN (BUNa) or steady-state BUN (BUNs) for intermittent hemodialysis (IHD) or continuous RRT (CRRT), respectively. The basis for the model was a group of 20 patients who received uninterrupted CRRT for at least 5 days. In these patients, the normalized protein catabolic rate (nPCR) increased linearly (r = 0.974) from 1.55 +/- 0.14 g/kg per day (mean +/- SEM) on day 1 to 1.95 +/- 0.15 g/kg per day on day 6. The daily urea generation rate (G), determined from the above linear relationship, was utilized to produce BUN versus time curves by the direct quantification method for simulated patients of varying dry weights (50 to 100 kg) who received variable CRRT urea clearances (500 to 2000 ml/h). Steady-state BUN versus time profiles for the same simulated patient population treated with IHD regimens (K = 180 ml/min, T = 4 h) of variable frequency were generated by use of a variable-volume, single-pool kinetic model. From these profiles, regression lines of required IHD frequency (per week) versus patient weight for desired BUNa values of 60, 80, and 100 mg/dl were obtained. Regression lines of required CRRT urea K (ml/h) versus patient weight for desired BUNs values of 60, 80, and 100 mg/dl were also generated. For the attainment of intensive IHD metabolic control (BUNa = 60 mg/dl) at steady state, a required treatment frequency of 4.4 dialyses per week is predicted for a 50-kg patient. However, the model predicts that the same degree of metabolic control cannot be achieved even with daily IHD Therapy in patients > or = 90 kg. On the other hand, for the attainment of intensive CRRT metabolic control (BUNs = 60 mg/dl), required urea clearance rates of approximately 900 ml/h and 1900 ml/h are predicted for 50- and 100-kg patients, respectively. This model suggests that, for many patients, rigorous azotemia control equivalent to that readily attainable with most CRRT can only be achieved with intensive IHD regimens. Following prospective clinical validation, this methodology may be a useful RRT prescription tool for critically ill ARF patients.
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azotemia control by Extracorporeal Therapy in patients with acute renal failure
New horizons (Baltimore Md.), 1995Co-Authors: W L Macias, W R ClarkAbstract:: The mortality rate for patients with acute renal failure (ARF) requiring renal replacement Therapy remains unacceptably high. The cause of death in these patients has been thought to relate primarily to the nature of the condition that precipitated renal failure. However, recent investigations challenge that notion and suggest that the characteristics of the renal replacement procedure itself may influence outcome. The major considerations for the clinician prescribing renal replacement Therapy to the patient with ARF are the Therapy mode, the type of membrane used, and the dose of delivered Therapy. The first two considerations have been discussed extensively in the medical literature and are reviewed elsewhere in this issue. However, the determination of the amount of delivered Therapy, although standard practice in patients with end-stage renal disease, has not been assessed routinely in patients with ARF. Furthermore, the influence on patient outcome of the level of azotemia control achieved by the delivered Therapy is unknown. The purpose of this review is to provide some insight into quantifying the amount of renal replacement Therapy delivered to patients with ARF treated with either continuous or intermittent therapies. The expected level of azotemia control that can be achieved with each of these therapies is discussed. We suggest that quantification of the amount of delivered Therapy and the level of azotemia control are important variables to be obtained and evaluated in future investigations seeking to understand the high mortality rate of patients with ARF.
