Suzuki / Hirasawa Acute Blood Purification

1. Auflage 2010
ISBN: 978-3-8055-9479-0
Verlag: S. Karger
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 166, 204 Seiten

Reihe: Contributions to Nephrology

Acute organ damage and the ensuing multiple organ failure are the result of a pathophysiological process involving various cytokines. Once activated, these proteins cannot be eliminated even when the kidneys function at their maximum capacity. To counteract this mechanism, researchers in Japan have developed an innovative concept employing blood purification to remove the overwhelming cytokines. This book describes the use of hemodiafiltration to inhibit the cytokine storms which cause serious organ damage in patients with septic shock. Moreover, the technical construction of the blood purification system, which includes various machines, devices, membranes, fluids, etc., is explained in detail. Finally, leading experts discuss the concept of continuous renal replacement therapy as the standard care in critically ill patients with severe acute kidney injury. Describing the current state of acute blood purification, this publication provides new impulses and opens new avenues in the treatment of acute organ damage.

Autoren/Hrsg.

Suzuki, H.

Hirasawa, H.

Weitere Mitwirkende

Ronco, C.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete AINS Intensivmedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Nephrologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gastroentereologie, Proktologie

Inhaltsverzeichnis

1;Cover;1
2;Contents;6
3;Preface;9
4;Introduction;10
4.1;References;12
5;Current Status;13
5.1;Current Status of Blood Purification in Critical Care in Japan;13
5.1.1;Abstract;13
5.1.2;Methods;14
5.1.3;Results;15
5.1.4;Discussion;16
5.1.5;Acknowledgement;18
5.1.6;References;18
6;Terminology and Indication;20
6.1;Terminology and Classification of Blood Purification in Critical Care in Japan;20
6.1.1;Abstract;20
6.1.2;Expressions of Blood Purification in Critical Care;21
6.1.3;Definitions of Continuous and Intermittent Therapies;22
6.1.4;Classification Based on the Purification Mode Using a Hemofilter;23
6.1.5;Classification of Blood Purification Based on the Blood Drawing and Returning Routes;23
6.1.6;Selection of CHD, CHF and CHDF Based on the Elimination Efficiency;24
6.1.7;Expressions Used when the Volume of Blood Purification Is Increased Intentionally above the Standard Level;25
6.1.8;Expressions Based on the Administration Route of Substitution Fluid;26
6.1.9;Terms used to Express Flow Rates;26
6.1.10;Classification and Expressions of Hemofilters;27
6.1.11;Conclusion;28
6.1.12;References;28
6.2;Indications for Blood Purification in Critical Care;30
6.2.1;Abstract;30
6.2.2;Blood Purification in Intensive Care Units;30
6.2.3;Indications for Blood Purification in ICU;31
6.2.4;Blood Purification for Hypercytokinemia and Sepsis;33
6.2.5;Future Perspectives;35
6.2.6;References;37
7;Acute Renal Failure;40
7.1;Acute Kidney Injury of Non-Septic Origin Requiring Dialysis Therapy;40
7.1.1;Abstract;40
7.1.2;Pathogenesis of AKI in Cardiovascular Surgery;40
7.1.3;Predictive Factors for the Risk of Postoperative Dialysis;41
7.1.4;Intraoperative Events;42
7.1.5;Postoperative Events;43
7.1.6;Beginning Dialysis Therapy;43
7.1.7;Conclusion;47
7.1.8;References;47
7.2;Septic Acute Renal Failure;49
7.2.1;Abstract;49
7.2.2;Pathophysiology;50
7.2.3;Therapy;51
7.2.4;References;53
8;Non-renal Indication;56
8.1;Non-Renal Indications for Continuous Renal Replacement Therapy: Current Status in Japan;56
8.1.1;Abstract;56
8.1.2;Blood Purification Advances in Japan;57
8.1.3;PMMA-CHDF;59
8.1.4;Plasma Diafiltration;59
8.1.5;Online CHDF;60
8.1.6;Cytokine-Adsorbing Column;60
8.1.7;Future Perspectives;60
8.1.8;References;61
8.2;Continuous Hemodiafiltration Using a Polymethyl Methacrylate Membrane Hemofilter for SevereAcute Pancreatitis;63
8.2.1;Abstract;63
8.2.2;Evaluation of the Magnitude of Hypercytokinemia in Patients with SAP;64
8.2.3;Criteria for Initiation of and Weaning from PMMA-CHDF;65
8.2.4;Effects of PMMA-CHDF on Blood IL-6 Level, Clinical Parameters and Outcome;68
8.2.5;Effects of PMMA-CHDF on Abdominal Compartment Syndrome;69
8.2.6;PMMA-CHDF as a Means of Cytokine Modulation;70
8.2.7;Conclusion;71
8.2.8;References;71
8.3;Blood Purification in Fulminant Hepatic Failure;73
8.3.1;Abstract;73
8.3.2;Purpose of Blood Purification;74
8.3.3;Hemodialysis and Hemofiltration;75
8.3.4;Plasmapheresis;76
8.3.5;Molecular Adsorbents Recirculating System;77
8.3.6;Bioartificial Liver Devices;77
8.3.7;Clinical Implementation of Blood Purification in Our Group;77
8.3.8;Conclusions;80
8.3.9;References;80
8.4;Treatment of Severe Sepsis and Septic Shock by CHDF Using a PMMA Membrane Hemofilter as a Cytokine Modulator;82
8.4.1;Abstract;82
8.4.2;Procedures in PMMA-CHDF for the Treatment of Severe Sepsis/Septic Shock;83
8.4.3;Cytokine-Removing Effects of PMMA-CHDF;84
8.4.4;Therapeutic Effects of Early Implementation of PMMA-CHDF in Septic Shock;84
8.4.5;Immunomodulatory Effects of Cytokine Removal by PMMA-CHDF on Immunocompetent Cells;87
8.4.6;Enhancement of the Cytokine-Removing Capacity of PMMA-CHDF to Cope with Refractory Septic Shock;89
8.4.7;Conclusion;89
8.4.8;References;90
8.5;Efficacy of Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in the Treatment of Acute Respiratory Distress Syndrome;92
8.5.1;Abstract;92
8.5.2;Materials and Methods;93
8.5.3;Results;95
8.5.4;Discussion;98
8.5.5;Conclusions;100
8.5.6;References;100
8.6;Blood Purification for Intoxication;102
8.6.1;Abstract;102
8.6.2;Indications for Blood Purification;103
8.6.3;Approach to Protein-Binding Substances;105
8.6.4;Case Presentation;106
8.6.5;Conclusion;108
8.6.6;References;108
9;Current Progresses in Methodology in Blood Purification in Critical Care;109
9.1;Current Progress in Blood Purification Methods Used in Critical Care Medicine;109
9.1.1;Abstract;109
9.1.2;Application of Blood Purification in Critical Care;110
9.1.3;Characteristics of Blood-Purification Methods Used in Critical Care;114
9.1.4;References;118
9.2;Membrane Materials for Blood Purification in Critical Care;121
9.2.1;Abstract;121
9.2.2;Materials and Methods;122
9.2.3;Results and Discussion;124
9.2.4;Conclusions;127
9.2.5;References;127
9.3;Anticoagulation in Acute Blood Purification for Acute Renal Failure in Critical Care;128
9.3.1;Abstract;128
9.3.2;Indications for Acute Blood Purification in Critical Care Patients;129
9.3.3;Modalities in Acute Blood Purification for ARF and Their Anticoagulation;129
9.3.4;Anticoagulation in Acute Blood Purification for ARF;131
9.3.5;Unfractionated Heparin;131
9.3.6;LMW Heparin;133
9.3.7;Nafamostat Mesilate;133
9.3.8;References;134
9.4;Equipment and Monitoring in Continuous Renal Replacement Therapy;135
9.4.1;Abstract;135
9.4.2;Selection of the Console System in CRRT;135
9.4.3;Composition and Monitoring of the CRRT Console;136
9.4.4;Management of CRRT Console System;141
9.4.5;References;142
9.5;Cytokine Adsorbing Columns;143
9.5.1;Abstract;143
9.5.2;CytoSorb Cartridge;145
9.5.3;CYT-860-DHP;145
9.5.4;Lixelle Column;146
9.5.5;CTR-001 Column;147
9.5.6;MPCF-X;148
9.5.7;Discussion;148
9.5.8;References;149
9.6;Plasma Dia-Filtration for Severe Sepsis;151
9.6.1;Abstract;151
9.6.2;Patients and Methods;152
9.6.3;Results;154
9.6.4;Discussion;156
9.6.5;Acknowledgement;157
9.6.6;References;157
9.7;Application of Polymyxin B Convalently Immobilized Fiber in Patients with Septic Shock;159
9.7.1;Abstract;159
9.7.2;Designing PMX;160
9.7.3;Animal Experiments;161
9.7.4;Clinical Studies;161
9.7.5;Drawbacks of Treatment with PMX-F;164
9.7.6;RCT of Treatment with PMX-F in Patients with Sepsis;164
9.7.7;Conclusion;165
9.7.8;References;165
9.8;Special Considerations in Continuous Hemodiafiltration with Critically Ill Pediatric Patients;167
9.8.1;Abstract;167
9.8.2;Advantages of CHDF over Intermittent Hemodialysis;168
9.8.3;CHDF Conditions for Pediatric Patients;168
9.8.4;Efficacy and Indications for CHDF in Pediatric Patients;168
9.8.5;Problems of CHDF in Pediatric Patients;169
9.8.6;Countermeasures to Problems Associated with CHDF in Pediatric Patients;169
9.8.7;Conclusions;174
9.8.8;References;174
10;Controversies in Blood Purification in Critical Care;176
10.1;Selection of Modality in Continuous Renal Replacement Therapy;176
10.1.1;Abstract;176
10.1.2;Modality in Continuous Renal Replacement Therapy (CRRT);176
10.1.3;Selection of Modality in CRRT: Survival in ICU Acute Renal Failure;177
10.1.4;Efficacy of CRRT in Other Conditions;178
10.1.5;Conclusions;180
10.1.6;References;180
10.2;Online CHDF System: Excellent Cost-Effectiveness for Continuous Renal Replacement Therapy with High Efficacy and Individualization;182
10.2.1;Abstract;182
10.2.2;Methods and Results;183
10.2.3;Discussion;186
10.2.4;Conclusion;188
10.2.5;References;189
11;New Technology;190
11.1;‘Super High-Flux’ or ’High Cut-Off’Hemofiltration and Hemodialysis;190
11.1.1;Abstract;190
11.1.2;SHF/HCO Hemofiltration;191
11.1.3;Ex vivo Findings with SHF/HCO Membranes;192
11.1.4;Pilot Clinical Study of SHF/HCO Hemofiltration;193
11.1.5;Effect of SHF/HCO Membrane on Cellular Function;193
11.1.6;Albumin Loss and Safety Issues;194
11.1.7;HCO Hemodialysis;195
11.1.8;Another Therapeutic Target: HMGB-1 and SHF/HCO Membrane;196
11.1.9;Conclusions;197
11.1.10;References;197
12;Author Index;199
13;Subject Index;200