The Experts below are selected from a list of 219 Experts worldwide ranked by ideXlab platform
Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.
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pilot study on the effects of high cutoff Hemofiltration on the need for norepinephrine in septic patients with acute renal failure
Critical Care Medicine, 2006Co-Authors: Stanislao Morgera, Michael Haase, Thomas Kuss, Ortrud Vargashein, Heidrun Zuckermannbecker, Christoph Melzer, Hanno Krieg, Brigitte Wegner, Rinaldo BellomoAbstract:OBJECTIVE High cutoff hemofilters are characterized by an increased effective pore size designed to facilitate the elimination of inflammatory mediators in sepsis. Clinical data on this new renal replacement modality are lacking. DESIGN Prospective, randomized clinical trial. SETTING University hospital, intensive care units. PATIENTS : Thirty patients with sepsis-induced acute renal failure. INTERVENTION Patients were allocated to high cutoff (n = 20) or conventional (n = 10) Hemofiltration in a 2:1 ratio. Median renal replacement dose was 31 mL/kg/hr. For high cutoff Hemofiltration, a high-flux hemofilter with an in vivo cutoff point of approximately 60 kilodaltons was used. Conventional Hemofiltration was performed with a standard high-flux hemofilter (PF11S). The impacts of high cutoff Hemofiltration on the need for norepinephrine and on plasma levels and clearance rates for interleukin (IL)-6 and IL-1 receptor antagonist (IL-1ra) were analyzed. Absolute values, but also adjusted values (expressed as proportion of baseline), were analyzed. The observation period was restricted to 48 hrs. MAIN RESULTS Apart from higher antithrombin III levels at entry into the study, main clinical and laboratory parameters were comparable between both groups. The median norepinephrine dose at entry into the study was 0.30 microg/kg/min in the high cutoff group and 0.21 microg/kg/min in the conventional Hemofiltration group (p = .448). Only the high cutoff group showed a significant decline (p = .0002) in "adjusted" norepinephrine dose over time. Clearance rates for IL-6 and IL-1ra were significantly higher in the high cutoff Hemofiltration group (p < .0001), which translated into a significant decline of the corresponding plasma levels (p = .0465 for IL-6; p = .0293 for IL-1ra). CONCLUSION In this pilot study, high cutoff Hemofiltration has been shown to exert a beneficial effect on the need for norepinephrine in septic patients with acute renal failure. In addition, we demonstrate that high cutoff Hemofiltration is superior to conventional Hemofiltration in the elimination of IL-6 and IL-1ra from the circulating blood of septic patients.
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The effect of continuous Hemofiltration on acid-base physiology
Current Opinion in Critical Care, 1999Co-Authors: Han Khim Tan, Rinaldo BellomoAbstract:Continuous Hemofiltration techniques have a powerful effect on acid-base physiology. In patients with metabolic acidosis, Hemofiltration techniques replace plasma water, which is low in bicarbonate concentration, with a solution, which contains either an above-normal bicarbonate concentration or a h
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Continuous Hemofiltration as blood purification in sepsis
New horizons (Baltimore Md.), 1995Co-Authors: Rinaldo BellomoAbstract:Continuous Hemofiltration was first described as a new form of renal replacement for critically ill patients in the late 1970s. Since then, it has undergone remarkable technical and conceptual modifications and has become a widely used form of dialytic therapy in the ICU. More recent insights into the pathogenesis of sepsis and the role of soluble molecules in the mediation of organ injury during septic shock have led to a resurgence of the concept of blood purification during life-threatening infection. Recent studies have confirmed that cytokine extraction occurs in vivo in humans during continuous Hemofiltration and that other smaller, potentially noxious molecules such as platelet-activating factor, complement factors C5a and C3a, and thromboxane are also removed from the circulation of septic patients or animals. Experimental studies have shown that continuous Hemofiltration has beneficial hemodynamic effects in septic animals and that such effects may correlate with the intensity of ultrafiltration. Cardiac function also appears to improve and myocardial depressant factors are removed from the circulation. Continuous Hemofiltration offers some promise as an adjunctive form of treatment in severe sepsis.
Peter Rogiers - One of the best experts on this subject based on the ideXlab platform.
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High-volume Hemofiltration in septic shock
Critical care (London England), 2005Co-Authors: Peter RogiersAbstract:In the past decade we have learned a lot about the pathophysiology of septic shock. A lot of experimental research has been performed in vitro and in vivo, showing that Hemofiltration can improve hemodynamics and survival. With modern machines, Hemofiltration is becoming a sepsis treatment in patients.
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Hemofiltration treatment for sepsis: Is it time for controlled trials?
Kidney International, 1999Co-Authors: Peter RogiersAbstract:Hemofiltration treatment for sepsis: Is it time for controlled trials? While the use of Hemofiltration to treat septic shock has potential benefits, the existing studies are difficult to compare because of their variety of inclusion criteria. The concept is to remove the various mediators of severe sepsis and septic shock, such as cytokines and eicosanoids, so that acute renal failure and the resultant multi-organ failure and possible death can be delayed or prevented. The dilemmas include: (a) Hemofiltration cannot distinguish between these pro-inflammatory mediators as they are of similar molecular weights, and thus it is difficult to determine which one or combination should be eliminated for the best hemodynamics; (b) timing of the Hemofiltration to remove a particular cytokine may make a difference in patient outcome; (c) the most efficacious convection rate of ultrafiltration has not been determined yet; (d) since these mediators quickly saturate the membrane, it should be frequently changed, and thus biocompatibility, availability and costs are added issues; (e) the choice of buffer is different according to the diagnosis of these critically ill patients. Before designing clinical trials, further experimentation is necessary to explore these problems
Christoph Busch - One of the best experts on this subject based on the ideXlab platform.
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attenuation of sepsis related immunoparalysis by continuous veno venous Hemofiltration in experimental porcine pancreatitis
Critical Care Medicine, 2001Co-Authors: Emre F Yekebas, Claus F Eisenberger, Henning Ohnesorge, Armin Saalmuller, Holgerandreas Elsner, Madelaine Engelhardt, Andrea Gillesen, Jan Meins, Tim Strate, Christoph BuschAbstract:ObjectivesIn light of evidence suggesting that Hemofiltration favorably influences septic diseases by removing sepsis mediators, the impact of different modalities of continuous veno-venous Hemofiltration (CVVH) on outcome and immunologic derangements in porcine pancreatogenic sepsis was evaluated.D
Eugen Faist - One of the best experts on this subject based on the ideXlab platform.
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Removal of mediators by continuous Hemofiltration in septic patients.
World journal of surgery, 2001Co-Authors: Johannes N. Hoffmann, Eugen FaistAbstract:Continuous Hemofiltration currently represents standard renal replacement therapy in critically ill patients. Because higher ultrafiltration rates are related to better survival rates in experimental and clinical studies and Hemofiltration results in fewer cardiovascular side effects than does conventional hemodialysis, the use of inflammatory mediator removal by this extracorporeal procedure has emerged. This article reviews clinically relevant principles of compound transport and the experimental and clinical effects of Hemofiltration during sepsis. Hemofiltration did not have a major impact on plasma concentrations of prominent inflammatory cytokines (tumor necrosis factor-a and interleukins 1b, 6, and 8) and seems therefore not to be able to counterbalance endogenous cytokine production despite considerable cytokine removal in the filtrate. Contradictory results in the literature are discussed under the viewpoint of membrane-related sieving coefficients and plasma cytokine measurement. A significant reduction in plasma anaphylatoxin concentrations by Hemofiltration is associated with impressive immunomodulatory and cardiodepressive ultrafiltrate effects. Thus far, however, the use of Hemofiltration for nonrenal indications remains experimental and is not supported by controlled clinical trials. Modern strategies of blood purification that may be associated with a high degree of effectiveness for mediator removal (high-volume Hemofiltration and heparin-induced extracorporeal lipoprotein-fibrinogen precipitation) are discussed.
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Hemofiltration in human sepsis: Evidence for elimination of immunomodulatory substances
Kidney international, 1995Co-Authors: Johannes N. Hoffmann, Wolfgang H. Hartl, Reinhold Deppisch, Eugen Faist, Marianne Jochum, Dietrich InthornAbstract:Hemofiltration in human sepsis: Evidence for elimination of immunomodulatory substances. Continuous Hemofiltration is widely used for renal replacement therapy in patients with acute renal failure. It has been suggested that Hemofiltration may also eliminate toxic mediators thought to be important in the pathophysiology of sepsis. The present study examined whether Hemofiltration can activate or eliminate inflammatory mediators in patients with sepsis, and whether ultrafiltrate can alter specific functions of peripheral blood mononuclear leukocytes (PBMC) in vitro . Veno-venous Hemofiltration was performed in 16 patients and in 5 healthy volunteers. Pre-filter (afferent), post-filter (efferent) and ultrafiltrate concentrations of cytokines (IL-1β, IL-6, IL-8, TNFα) and of complement components (C3, C3a desArg , C5a desArg , terminal complement complex) were measured after the beginning of Hemofiltration (t 0 ), and 60 minutes later (t 60 ). PBMC, and monocyte and lymphocyte subfractions were incubated with ultrafiltrate, and cytokines were determined in the supernatants. Hemofiltration did not induce significant mediator activation. There was no evidence for significant cytokine elimination. However, pre-filter C3a desArg concentration showed a significant decline during Hemofiltration (patients: t 0 = 676.9 ± 99.7 ng/ml, t 60 = 545.4 ± 83.2, P 0 = 54.8 ± 13.3 ng/ml, t 60 = 33.9 ± 10.7, P desArg . Ultrafiltrate contains compounds with significant immunomodulatory qualities. Therefore, Hemofiltration may represent a new modality for removal of immunomodulatory mediators.
Chandra Mohan - One of the best experts on this subject based on the ideXlab platform.
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treatment outcome of combined continuous venovenous Hemofiltration and hemoperfusion in acute paraquat poisoning a prospective controlled trial
Critical Care Medicine, 2018Co-Authors: Wen Xue, Zhen Wang, Yaxiang Song, Xinying Liu, Jiafeng Cheng, Shuling Fan, Limin Zhao, Liya Wang, Chandra MohanAbstract:Objectives To investigate whether combined continuous venovenous Hemofiltration and hemoperfusion among paraquat-poisoned patients would improve survival. Design Prospective, controlled interventional study over 4 years. Setting Single, tertiary, academic medical center. Patients We recruited patients admitted to Shanghai Tenth People's Hospital within 48 hours after paraquat ingestion. Exclusions were under 14 years old, ingestion of paraquat with other toxicants, pregnant, a history of chronic pulmonary disease, psychosis, hyperthyroidism, or diabetes with impaired liver or renal function. Interventions All patients were assigned to receive continuous venovenous Hemofiltration with hemoperfusion therapy (continuous venovenous Hemofiltration group) and to receive conventional therapy (conventional group). The study outcomes were death from any cause within 90 days after paraquat ingestion and the frequencies of hypoxia, acute kidney injury, or adverse events. Measurements and main results Of the 110 enrolled patients, 59 were assigned to continuous venovenous Hemofiltration group and 51 to conventional group. The two groups had similar baseline demographics and clinical features. At 90 days after paraquat ingestion, 19 of 59 patients (32.2%) in the continuous venovenous Hemofiltration group and 29 of 51 patients (56.9%) in the conventional group had died (hazard ratio, 0.43; 95% CI, 0.24-0.76; p = 0.004). In multivariable Cox proportional hazard models controlling for baseline characteristics, combined continuous venovenous Hemofiltration and hemoperfusion was independently associated with reduced risk of death compared with conventional therapy (adjusted hazard ratio, 0.35; 95% CI, 0.19-0.64; p = 0.001). Patients in the continuous venovenous Hemofiltration group, as compared to the conventional group, had a reduced occurrence rate of hypoxia (40.7% vs 72.5%; p = 0.001) and of acute kidney injury (59.3% vs 78.4%; p = 0.03). Hypophosphatemia and thrombocytopenia were more common in the continuous venovenous Hemofiltration group (p Conclusions In patients with paraquat poisoning, treatment with combined continuous venovenous Hemofiltration and hemoperfusion significantly improved 90-day survival rates.
