Acid base variables predict survival early in the course of treatment with continuous venovenous hemodiafiltration

Passos, Rogério da Hora; Caldas, Juliana; Ramos, João Gabriel Rosa; Batista, Paulo Benígno Pena; Noritomi, Danilo Teixeira; Akamine, Nelson; Durão, Marcelino de Souza; Santos, Bento Fortunato Cardoso dos; Pereira, Virgilio Gonçalves; Monte, Julio Cesar Martins; Batista, Marcelo Costa; Santos, Oscar Fernando Pavão dos

doi:10.1097/md.0000000000012221

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Interestingly, due to the acid-base composition change achieved when a high dialysate pH was set in treatment of acidosis, the ADVOS procedure supported normalization of systemic blood pH with low blood flow rates (100-200 ml/min) within 6 h, even in cases that were refractory to conventional renal replacement therapies [51]. Furthermore, a correlation between dialysate pH set and pCO 2 reduction of up to 40 mmHg (− 23 mmHg, IQR: − 37, − 7) between the inlet and the outlet of the dialyzer could be observed.…”

Section: Discussionmentioning

confidence: 99%

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Fuhrmann

Weber

Roedl

et al. 2020

Ann. Intensive Care

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Background: Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid-base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF. Methods: 34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acidbase regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2). Results: Median number of treatment sessions was 2 (range 1-9) per patient. Median duration of treatment was 17.5 (IQR 11-23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO 3 − and PaCO 2 , was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO 3 − and PaCO 2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively. Conclusions: In this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albuminbound substances. Furthermore, the device corrected severe metabolic and respiratory acid-base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.

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Section: Discussionmentioning

confidence: 99%

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Fuhrmann

Weber

Roedl

et al. 2020

Ann. Intensive Care

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“…In a study examining septic patients with AKI who underwent CVVHDF, Passos et al found that lactic acid levels at the start of treatment were higher in patients who died, although the difference was not significant. However, lactic acid levels measured 3 days after starting CVVHDF therapy were significantly higher in the deceased group [15]. A similar study reported that lactic acidosis may be an indicator of early mortality in patients undergoing CRRT [16].…”

mentioning

confidence: 72%

Mortality predictors in acute kidney injury patients who underwent continuous venovenous hemodiafiltration: A retrospective, single-center study

Alp

Akdam

Akar

et al. 2021

Ukr. J. Nephrol. and Dial.

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Continuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF. Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived. Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p<0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p<0.001, chi-square test). Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF.

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“…Otra variable ampliamente estudiada como predictora de mortalidad en diferentes escenarios clínicos es la BE. Algunos estudios han reportado relación de la BE con los resultados clínicos adversos incluyendo la mortalidad, en poblaciones específicas de pacientes críticos (17,18), especialmente en pacientes con trauma (19)(20)(21), sin embargo, un estudio Realizado por Masevicius et al (22), en una UCI médico-quirúrgica donde recolectaron 4901 pacientes durante 9 años, no mostró asociación de la BE con la mortalidad hospitalaria (22). En el presente estudio la BEst no mostró significancia estadística en el análisis bivariado.…”

Section: Consideraciones éTicasunclassified

Variables fisiológicas del “componente metabólico” del estado ácido base y mortalidad en pacientes de cuidados intensivos

2021

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Introducción. La acidosis metabólica es una condición fisiopatológica frecuente en pacientes críticos. Esta alteración es evaluada mediante diferentes variables fisiológicas; sin embargo, su valor pronóstico aún no está bien definido. Objetivo. Evaluar la asociación entre variables del componente metabólico del estado ácido base (EAB) y mortalidad a 28 días en pacientes de una unidad de cuidados intensivos (UCI) en Bogotá D.C., Colombia. Materiales y métodos. Estudio de cohorte prospectivo realizado en 122 pacientes hospitalizados en una UCI entre enero y junio de 2013 y con una estancia mayor a 24 horas. Se tomaron muestras sanguíneas y gases arteriales de ingreso para el cálculo de las siguientes variables: Anion Gap (AG), Anion Gap corregido (AGc), Base exceso estándar (BEst), H+ metabólicos, Base exceso-aniones no medibles (BEua), pH, lactato, HCO3-st, Brecha de iones fuertes (BIF), puntaje Apache II, y puntaje SOFA. Se realizó un análisis bivariado, calculándose OR con un nivel de significancia de p<0.05, y luego uno multivariado, mediante un modelo de regresión logística, para identificar las variables asociadas con la mortalidad a 28 días. Resultados. De los 122 pacientes, 33 (27.7%) fallecieron a 28 días y 51 (48.7%) eran mujeres. La edad promedio fue 46.5 años (±15.7). En el análisis bivariado, las siguientes variables se asociaron significativamente con la mortalidad a 28 días: BIF: OR=1.150 (p=0.008), BEua: OR=0,897 (p=0.023), AG: OR=1.231 (p=0.002), AGc: OR=1.232, (p=0.003), pH arterial: OR=0.001, (p=0.023), APACHE II: OR=1.180 (p=0.001), HCO3- st: OR=0.841 (p=0.015). En el análisis multivariado, solo el puntaje APACHE II se asoció significativamente con la mortalidad a 28 días: OR=1.188 (p=0.008). Conclusión. Las variables fisiológicas que evalúan el componente metabólico del estado ácido-base, tanto las del modelo de Henderson, como las del modelo de Stewart, no se asociaron significativamente con la mortalidad a 28 días en la población de estudio.

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Acid base variables predict survival early in the course of treatment with continuous venovenous hemodiafiltration

Cited by 5 publications

References 34 publications

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Mortality predictors in acute kidney injury patients who underwent continuous venovenous hemodiafiltration: A retrospective, single-center study

Variables fisiológicas del “componente metabólico” del estado ácido base y mortalidad en pacientes de cuidados intensivos

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