BACKGROUND: In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA). METHODS: Thirteen critically ill patients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions). RESULTS: Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionized calcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present. CONCLUSIONS: These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.
BACKGROUND: In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA). METHODS: Thirteen critically illpatients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions). RESULTS: Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionizedcalcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present. CONCLUSIONS: These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septicpatients treated by CPFA.
Authors: Elena Garbero; Sergio Livigni; Fiorenza Ferrari; Stefano Finazzi; Martin Langer; Paolo Malacarne; Manlio Cosimo Claudio Meca; Sabino Mosca; Carlo Olivieri; Marco Pozzato; Carlotta Rossi; Mario Tavola; Marina Terzitta; Bruno Viaggi; Guido Bertolini Journal: Intensive Care Med Date: 2021-10-03 Impact factor: 17.440
Authors: Gabriele Donati; Andrea Angeletti; Lorenzo Gasperoni; Fabio Piscaglia; Anna Laura Croci Chiocchini; Anna Scrivo; Teresa Natali; Ines Ullo; Chiara Guglielmo; Patrizia Simoni; Rita Mancini; Luigi Bolondi; Gaetano La Manna Journal: J Nephrol Date: 2020-07-24 Impact factor: 3.902
Authors: Filippo Mariano; Vincenzo Cantaluppi; Maurizio Stella; Giuseppe Mauriello Romanazzi; Barbara Assenzio; Monica Cairo; Luigi Biancone; Giorgio Triolo; V Marco Ranieri; Giovanni Camussi Journal: Crit Care Date: 2008-03-25 Impact factor: 9.097