Severe Accidental Hypothermia Managed with Continuous Venovenous Hemofiltration

Puzio, Thaddeus J.; Chrobak, David; Jawed, Yameena; Tripathy, Purnima R.; Carlos, W. Graham

doi:10.1177/000313482008600131

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…The mean rate of rewarming calculated for all studies combined was 1.9 • C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 • C/h; 95% CI 0.9-3.0) and intermittent (1.9 • C/h; 95% CI 1.5-2.3) methods (p > 0.9). The lowest reported rewarming rate was 0.6 • C/h and the highest 4 • C/h, both were achieved with the continuous RRT [17,18]. For continuous renal replacement therapy (CRRT), the median rewarming time was 4.5 h (IQR 3.3-6.1), the initial median temperature 26.0 • C (IQR 22.5-30.4), and the final temperature 33.0 • C (IQR 30.6-35.5).…”

Section: Resultsmentioning

confidence: 96%

“…It is also a common belief that extracorporeal devices which do not support the circulation (such as hemodialysis) are relatively contraindicated as they can compromise the hemodynamics and are ineffective in the absence of spontaneous circulation. However, as shown in this review, reports exist of RRT being used to rewarm a patient in CA with good neurological outcomes [16,18,19,22,23].…”

Section: Discussionmentioning

confidence: 95%

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The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia—Systematic Review of the Literature

Mendrala

Kosiński

Podsiadło

et al. 2021

IJERPH

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Background: Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C. Methods: This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021. Results: From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5–2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9–3.0) and intermittent (1.9 °C/h; 95% CI 1.5–2.3) methods (p > 0.9). Conclusions: Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines.

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 95%

The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia—Systematic Review of the Literature

Mendrala

Kosiński

Podsiadło

et al. 2021

IJERPH

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“…The reports vary in the RRT technique, additional rewarming methods used, and patient core temperature at presentation. Examples of successful implementation of CVVHDF in hypothermic cardiac arrest have also been described 17‐25 . Interestingly, one of the studies described the use of CRRT as a heat exchanger during ECMO therapy (due to technical reasons, a dedicated heater cooler was not available) 24 …”

Section: Discussionmentioning

confidence: 99%

“…Examples of successful implementation of CVVHDF in hypothermic cardiac arrest have also been described. [17][18][19][20][21][22][23][24][25] Interestingly, one of the studies described the use of CRRT as a heat exchanger during ECMO therapy (due to technical reasons, a dedicated heater cooler was not available). 24 The optimal rewarming rate in severely hypothermic patients has not been established, and currently is drawn from the experience of the various centers.…”

Section: Discussionmentioning

confidence: 99%

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia––An experimental study

et al. 2021

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Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno‐venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the “central compartment” of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: “blood” (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for “blood” flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9‐122.6 minutes), 83.3 minutes (95% CI, 76.2‐90.3 minutes), and 74.7 minutes (95% CI, 62.6‐86.9 minutes), respectively (P < .01). The respective median rewarming rate for different “blood” flows was 3.6°C/h (IQR, 3.0‐4.2°C/h), 4.8 (IQR, 4.2‐5.4°C/h), and 5.4 (IQR, 4.8‐6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.

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“…[ 8 ] Conversely, hemofiltration, the most common modality, is continuous venovenous hemofiltration, not only help eliminate the toxins from the blood and regulate the body fluid balance but also clear the large number of inflammatory mediators and inflammatory factors. [ 9 ]…”

Section: Introductionmentioning

confidence: 99%

Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning

Wang

Zhang

et al. 2022

Journal of Research in Medical Sciences

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Background: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP. Materials and Methods: A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1. Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD −147.34 mg, 95% CI [−199.49, −95.18], P < 0.001), duration of mechanical ventilation (WMD −2.34 days, 95% CI [−3.77, −0.92], P < 0.001), cholinesterase recovery time (WMD −2.49 days, 95% CI [−3.14, −1.83], P < 0.001), and length of stay (WMD −4.52 days, 95% CI [−5.31, −3.73], P < 0.001). Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.

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Severe Accidental Hypothermia Managed with Continuous Venovenous Hemofiltration

Cited by 3 publications

References 4 publications

The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia—Systematic Review of the Literature

The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia—Systematic Review of the Literature

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia––An experimental study

Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning

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