Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure
Standard
Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure. / Fuhrmann, Valentin; Weber, Theresa; Roedl, Kevin; Motaabbed, Jasmin; Tariparast, Adel; Jarczak, Dominik; de Garibay, Aritz Perez Ruiz; Kluwe, Johannes; Boenisch, Olaf; Herkner, Harald; Kellum, John A; Kluge, Stefan.
In: ANN INTENSIVE CARE, Vol. 10, No. 1, 16.07.2020, p. 96.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure
AU - Fuhrmann, Valentin
AU - Weber, Theresa
AU - Roedl, Kevin
AU - Motaabbed, Jasmin
AU - Tariparast, Adel
AU - Jarczak, Dominik
AU - de Garibay, Aritz Perez Ruiz
AU - Kluwe, Johannes
AU - Boenisch, Olaf
AU - Herkner, Harald
AU - Kellum, John A
AU - Kluge, Stefan
PY - 2020/7/16
Y1 - 2020/7/16
N2 - 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 acid-base 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, HCO3- and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3- and PaCO2 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 albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid-base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.
AB - 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 acid-base 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, HCO3- and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3- and PaCO2 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 albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid-base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.
U2 - 10.1186/s13613-020-00714-3
DO - 10.1186/s13613-020-00714-3
M3 - SCORING: Journal article
C2 - 32676849
VL - 10
SP - 96
JO - ANN INTENSIVE CARE
JF - ANN INTENSIVE CARE
SN - 2110-5820
IS - 1
ER -