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[Safety and efficacy of the MARS therapy applied by continuous renal replacement therapy (CRRT) monitors].

Abstract：

OBJECTIVE:Analyze the utility and safety of MARS therapy applied with the CRRT monitor. DESIGN:Prospective study of cohorts. SCOPE:Polyvalent ICU in tertiary university hospital with hepatic transplantation program. PATIENTS:Thirty one patients: 9 (22.6%) with acute liver failure (ALF) (1 hepatic surgery, 1 primary graft failure, 7 other causes) and 22 (71%) with acute-on-chronic failure (AoCLF). INTERVENTIONS:For the treatment, the patients with ALF are maintained in the ICU but those with AoCLF are admitted for the performance of the different sessions, that are programmed for a duration of at least 15 hours in AoCLF and in ALF are maintained continuously, changing the circuit every 24 hours. VARIABLES OF INTEREST:Metabolic control and complications registered in 75 sessions on 31 patients. RESULTS:Urea decrease was 33.5 (29-38%), creatinine 36 (31-41%), total bilirubin 29 (25-33%) and direct bilirubin 34 (30-38%). Clearance was slower, but sustained, after the first 4 hours of each session both for urea (p<0.001) as well as for bilirubin (p<0.05). The hemodynamic parameters improved and the hematological ones were not altered. We detected decrease in platelets (131 to 120x109/L, p<0.01). In 95 of the sessions in which heparin was used and in 6% where epoprostenol was used, we observed mild bleeding. We cultured albumin of the circuit at the end of the session in 50 occasions and only obtained growth in 3 cases (6%) (2 Staphylococcus epidermidis, 1 S. haemolyticus) without signs of contamination in the patients. CONCLUSIONS:The MARS system applied by CRRT monitors provide adequate bilirubin clearance percentages and is safe, even in serious patients. Prolongation of the duration of the sessions was not accompanied by an increase in the risk of infection secondary to the albumin contamination.

journal_name

Med Intensiva

journal_title

Medicina intensiva

authors

Herrera-Gutiérrez ME,Seller-Pérez G,Lebrón-Gallardo M,Jiménez-Pérez M,Moreno-López JM,Muñoz-López A

doi

10.1016/s0210-5691(07)74841-6

subject

Has Abstract

pub_date

2007-10-01 00:00:00

pages

367-74

issue

eissn

0210-5691

issn

1578-6749

pii

13110703

journal_volume

pub_type

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[Safety and efficacy of the MARS therapy applied by continuous renal replacement therapy (CRRT) monitors].