Continuous veno-venous haemofiltration following cardio-pulmonary bypass

Baudouin, Simon; Wiggins, J; Keogh, Brian F; Morgan, Cliff; Evans, Timothy W.

doi:10.1007/bf01690550

Cited by 54 publications

(31 citation statements)

References 17 publications

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“…Given the physiological advantages of HF, it is disappointing that several clinical studies have so far failed to demonstrate evidence of a survival advantage [32, 33]. There are, in our opinion, some potential explanations for this failure.…”

Section: The Effect Of Therapy On Outcomesmentioning

confidence: 88%

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Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

2001

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Fluid overload is common before, during and after cardiac surgery. The fluid associated with cardiopulmonary bypass (CPB) and cardioplegia is a particularly important source of such fluid overload. In addition, renal dysfunction, which is common in these patients, participates in the pathogenesis of a positive sodium and water balance. Such fluid overload is physiologically undesirable and participates in the pathogenesis of several clinically important complications. Fluid overload can be partly prevented with the use of diuretics. However, in many patients, diuretics do not achieve sufficient sodium and water diuresis. In these patients, the application of hemofiltration (HF) during CPB and also immediately after CPB is an effective and safe approach to the maintenance of fluid homeostasis. If acute renal failure occurs, early intervention with HF may even improve survival.

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Section: The Effect Of Therapy On Outcomesmentioning

confidence: 88%

“…Baudouin et al [32]reported a >80% mortality rate in their study of similar patients. In this series, however, CVVH was initiated much later (>8 days postoperatively) than in our patients, and the delay in initiating CVVH identified patients more likely to die.…”

Section: The Effect Of Therapy On Outcomesmentioning

confidence: 99%

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

2001

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“…To remove the excessive volume and inflammatory mediators, RRT might be necessary to improve prognosis. [28][29][30][31][32][33] It is known that RRT is beneficial to patients with sepsis-related MODS because of its capacity to remove cytokines; early use of RRT might improve prognosis in patients with SIRS and sepsis. [34][35][36][37] It was demonstrated that early initiation of CRRT could improve outcome in AKI patients who underwent cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Analyzing Chinese Patients with Post-Operative Acute Kidney Injury

et al. 2011

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Background: To investigate clinical characteristics and risk factors of Chinese patients with post-operative acute kidney injury (PO-AKI). Methods: Patients with PO-AKI in Ruijin Hospital from December 1997 to December 2005 were retrospectively studied. Results: Patients' mean age was 62.2 ± 18.1 years. There were 111 males and 57 females. The mean serum creatinine at diagnosis was 370.41 ± 320.92 µmol/L and the mean estimated glomerular filtration rate was 33.56 ± 24.24 mL/min. For the outcome of the patients, 38 died and the mortality rate was 22.6%. There were 17 patients (10.1%) with Acute Dialysis Quality Initiative-RIFLE (risk-injury-failure-loss-end classification) phase R, 21 (12.5%) with phase I, and 130 (77.4%) with phase F. There was no significant difference in mortality regarding patients who underwent different types of surgeries. For the risk factors related to PO-AKI, acute tubular necrosis (ATN) increased relative risk of mortality PO-AKI (odds ratio = 7.089, 95% confidence interval = 2.069-24.288, p < 0.001). Multivariate regression models showed that ATN had a positive correlation with mortality of PO-AKI. Conclusions: PO-AKI is one of the most common causes of AKI in patients who underwent operations. Special attention should be paid to risk factors related to PO-AKI in order to improve prognosis.

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“…Treatment modalities included continuous haemofiltration, either arteriovenous [23,26,28-32,37,45,-46,50-53,59], venovenous [36,38,47,49,60,66] or both [34,35,44,55], slow continuous ultrafiltration [6], continuous haemodialysis, either arteriovenous [39,41,54,56,58,61,65,68], venovenous [25,31] or both [9,24,42,62,63], continuous haemodiafiltration [40,48,67,69] as well as both continuous arteriovenous haemofiltration and haemodialysis [43,57] respectively. In one study continuous RRT was combined with intermittent haemodialysis [29].…”

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confidence: 99%

“…The types of niters used were mostly polyacrylonitrile [9,24,25,28,31,[33][34][35][37][38][39][40][41][42]48,53,58,61,65,66,[68][69][70], but also polysulphone [6,23,26,30,31,36,43,[49][50][51]57] or polyamide [32,44,46,47,51,55,56,58,70] niters have been used. In some studies the type of filter prescribed was not indicated.…”

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confidence: 99%

Does continuous renal replacement therapy favourably influence the outcome of the patients?

Jakob

Frey

Uehlinger

1996

Nephrology Dialysis Transplantation

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Continuous haemodialysis and continuous haemofiltration are efficient and safe techniques for the treatment of acute renal failure. Theoretical advantages are improved haemodynamic stability and easier fluid removal. All 15 available studies comparing intermittent (522 patients) with continuous (651 patients) renal replacement therapy have been reviewed. From these studies it cannot be established, whether the use of a continuous instead of an intermittent treatment modality improves the outcome in patients with acute renal failure. Reviewing all 67 published studies dealing with continuous renal replacement therapy revealed a trend to a decreasing mortality rate (/><0.08) over the last 11 years, whereas the mean age and the severity of illness of the patients, measured by the APACHE II score, did not change. In order to establish whether the quality of treatment has improved as a function of time, two quality factors (QF) were created, i.e. QF for age (mean age/mean mortality rate of the patients treated) and QF for severity of diseases (mean APACHE II/mean mortality rate). Both QF improved from 1984 until 1994, when analyzed for continuous (P< 0.001) or intermittent (P< 0.001) treatment modality. Thus the quality of treatment of patients with acute renal failure improved during the last decade. However, there is no evidence with respect to survival rate that a continuous renal replacement therapy is superior to an intermittent one.

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Continuous veno-venous haemofiltration following cardio-pulmonary bypass

Abstract: Despite the theoretical advantages of haemofiltration and the effective control of uraemia the mortality associated with ARF following CPB remains high and is probably determined by the number of failed organs systems.

Cited by 54 publications

References 17 publications

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

Analyzing Chinese Patients with Post-Operative Acute Kidney Injury

Does continuous renal replacement therapy favourably influence the outcome of the patients?

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