Early Initiation of Continuous Renal Replacement Therapy Improves Clinical Outcomes in Patients With Acute Respiratory Distress Syndrome

Han, Fei; Sun, Renhua; Yin, Ning; Hu, Xiuping; Chen, Xv; Jiang, Lingzhi; Wu, Aiping; Ma, Liang; Chen, Minhua; Xv, Yunxiang; Tu, Yuexing

doi:10.1097/maj.0000000000000379

Cited by 52 publications

(50 citation statements)

References 42 publications

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“…CRRT, one of extracorporeal treatments, has been used for critically ill patients with or without AKI or acute kidney failure and ARDS is one of nonrenal indications for CRRT [11]. Studies showed that CRRT brought benefits to ARDS patients (non-AKI), including improvement of oxygenation and survival [14, 25]. We used CVVH, one of CRRT, in the current study and we found significant improvement of EVLWI in both groups after initiation of treatment.…”

Section: Discussionmentioning

confidence: 59%

“…Early CRRT was found as an independent factor associated with a lower mortality rate, the severity of disease, and causative organisms in the patients with septic acute kidney injury [29]. Early CRRT helps to reduce EVLWI, improve PaO 2 /FiO 2 and Cdyn, and shorten duration on ventilation in ARDS patients [25]. In this study, we find significant improvements in EVLWI, PaO 2 /FiO 2 , Cdyn, Pplat, and PEEP, which are consistent with these studies.…”

Section: Discussionmentioning

confidence: 99%

“…ECVVH reached the goal of negative fluid balance in the early stage of septic shock, and EVLW could be decreased through the fluid removal during CVVH. Recent clinical and animal studies showed that CVVH was associated with improved oxygenation and organ function, facilitated fluid removal, and decreased EVLW in ALI/ARDS patients [25, 28]. Many cytokines and biomarkers, including endothelial and epithelial alveolar biomarkers, involved in the pathogenesis of ARDS and sepsis are released and it is believed that CVVH attenuates the entire inflammatory response and reduces the levels of biomarkers via removal of cytokines [14, 36].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Meng

Lai

et al. 2016

BioMed Research International

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Objective. To investigate the effects of 72-hour early-initiated continuous venovenous hemofiltration (ECVVH) treatment in patients with septic-shock-induced acute respiratory distress syndrome (ARDS) (not acute kidney injury, AKI) with regard to serum E-selectin and measurements of lung function and hemodynamic stability. Methods. This prospective nonblinded single institutional randomized study involved 51 patients who were randomly assigned to receive or not receive ECVVH, an ECVVH group (n = 24) and a non-ECVVH group (n = 27). Besides standard therapies, patients in ECVVH group underwent CVVH for 72 h. Results. At 0 and 24 h after initiation of treatment, arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, extravascular lung water index (EVLWI), and E-selectin level were not significantly different between groups (all P > 0.05). Compared to non-ECVVH group, PaO2/FiO2 is significantly higher and EVLWI and E-selectin level are significantly lower in ECVVH group (all P < 0.05) at 48 h and 72 h after initiation of treatment. The lengths of mechanical ventilation and stay in intensive care unit (ICU) were shorter in ECVVH group (all P < 0.05), but there was no difference in 28-day mortality between two groups. Conclusions. In patients with septic-shock-induced ARDS (not AKI), treatment with ECVVH in addition to standard therapies improves endothelial function, lung function, and hemodynamic stability and reduces the lengths of mechanical ventilation and stay in ICU.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Meng

Lai

et al. 2016

BioMed Research International

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“…Although CBP treatment for ARDS patients has not been written in guidelines, its functions such as clearance of inflammatory mediators, suppression of body reaction to pro-inflammation and anti-inflammation, stabilization of hemodynamics, and improvement of organ functions have been reported and adopted many times in the recent decade (9,10,12,14). To summurize, at present, the main mechanisms of blood purification in the treatment of ARDS are ultrafiltration of liquid, maintenance of a low temperature for reduction of oxygen consumption, reduction of extravascular lung water content, and elimination of inflammation factors (15). …”

Section: Discussionmentioning

confidence: 99%

Continuous blood purification treatment for endotoxin-induced acute respiratory distress syndrome

Jiang

Lin

et al. 2017

Braz J Med Biol Res

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This study aimed to explore the effects of continuous blood purification (CBP) treatment in pigs affected with acute respiratory distress syndrome (ARDS). A total of 12 healthy male pigs, weighing 12±1.8 kg, were randomly and equally assigned to the control and experimental groups. The ARDS pig model was prepared by intravenous injections of endotoxin (20 µg/kg). The control group was given conventional supportive therapy, while the experimental group was given continuous veno-venous hemofiltration therapy. During the treatment process, the variations in dynamic lung compliance, oxygenation index, hemodynamics, and urine volume per hour at different times (Baseline, 0, 2, 4, and 6 h) were recorded. The levels of tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and IL-10 in serum and bronchoalveolar lavage fluid (BALF) were measured using the enzyme-linked immunosorbent assay. The histomorphological changes of the lung, heart, and kidney were visualized using a light microscope. The nuclear factor κB p65 protein content of the heart, lung, and kidney tissues was also detected using western blot. The experimental group outperformed the control group in both respiratory and hemodynamic events. CBP treatment cleared TNF-α, IL-6, and IL-10 partially from serum and BALF. The pathological examination of the heart, lung, and kidney tissues revealed that the injury was less severe in the experimental group. CBP treatment can improve the organ functions of pigs affected with endotoxin-induced ARDS and protect these organs to some extent.

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“…Inflammatory factor storm is a major pathophysiological mechanism in the pathogenesis of severe and critical cases of COVID-19 [11]. The effective elimination of inflammatory factors through the blood purification program could avoid multiorgan functional damage, improve the cure rate, and reduce mortality [13][14][15]. In the clinical course of patients with severe-and critical-type COVID-19, we propose the following recommendations for kidney support therapy and blood purification therapy.…”

Section: Renal Function Supportmentioning

confidence: 99%

Organ function support in patients with coronavirus disease 2019: Tongji experience

Zhou

et al. 2020

Front. Med.

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Coronavirus disease 2019 (COVID-19) is a highly contagious disease and a serious threat to human health. COVID-19 can cause multiple organ dysfunction, such as respiratory and circulatory failure, liver and kidney injury, disseminated intravascular coagulation, and thromboembolism, and even death. The World Health Organization reports that the mortality rate of severe-type COVID-19 is over 50%. Currently, the number of severe cases worldwide has increased rapidly, but the experience in the treatment of infected patients is still limited. Given the lack of specific antiviral drugs, multi-organ function support treatment is important for patients with COVID-19. To improve the cure rate and reduce the mortality of patients with severe-and critical-type COVID-19, this paper summarizes the experience of organ function support in patients with severe-and criticaltype COVID-19 in Optical Valley Branch of Tongji Hospital, Wuhan, China. This paper systematically summarizes the procedures of functional support therapies for multiple organs and systems, including respiratory, circulatory, renal, hepatic, and hematological systems, among patients with severe-and critical-type COVID-19. This paper provides a clinical reference and a new strategy for the optimal treatment of COVID-19 worldwide.

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Early Initiation of Continuous Renal Replacement Therapy Improves Clinical Outcomes in Patients With Acute Respiratory Distress Syndrome

Cited by 52 publications

References 42 publications

Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Continuous blood purification treatment for endotoxin-induced acute respiratory distress syndrome

Organ function support in patients with coronavirus disease 2019: Tongji experience

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