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R Bellomo

Publications and source records attributed to R Bellomo.

At least 199 records · Page 11Linked to original sources
PubMed1994

Use of a mean systemic filling pressure analogue during the closed-loop control of fluid replacement in continuous hemodiafiltration.

PURPOSE: To assess the use and validity of a mean systemic filling pressure analogue (Pmsa) in the closed-loop control of fluid replacement in continuous hemodiafiltration. METHODS: Cardiovascular variables were computer acquired from bedside monitor. Pmsa was calculated and compared with a target value. Gravitational fluid replacement to the extracorporeal hemodiafiltration circuit was regulated with a computer-controlled clamp. RESULTS: Ten patients (mean acute physiology and chronic health evaluation II score, 29.7; range, 21-33) received continuous venovenous hemodiafiltration for acute renal failure. Fluid replacement therapy was closed loop controlled to a target Pmsa for a total of 601 hours. During this period, 417 L of ultradiafiltrate were lost, and 409 L of replacement and nutritional fluids were administered. Despite such large fluid shifts, measured hemodynamic variables were kept within a narrow range (hour to hour variability: right atrial pressure, 1 +/- 0.1 mm Hg; mean arterial pressure 5.9 +/- 0.5 mm Hg; cardiac index, 0.44 +/- 0.05 L/m2/min). No complications of the technique occurred. CONCLUSIONS: The stability of cardiovascular variables achieved during Pmsa-based fluid replacement of critically ill patients with major fluid losses supports the validity of the use of the Pmsa as a measure of intravascular volume status. Such an analogue may be useful in nondialytic environments. The use of Pmsa as the basis for automated fluid replacement was safe.

Acute Kidney Injury↗
PubMed1994

Effect of continuous venovenous hemofiltration with dialysis on hormone and catecholamine clearance in critically ill patients with acute renal failure.

OBJECTIVES: To measure the effect of continuous venovenous hemofiltration with dialysis on cardiovascular stability in the critically ill patients and to assess the extraction of a number of hormones and catecholamines by continuous venovenous hemofiltration with dialysis. DESIGN: Prospective, clinical study. SETTING: Intensive care unit of a tertiary medical center. PATIENTS: Twenty critically ill patients with acute renal failure. INTERVENTIONS: Timed collections of serum and ultradiafiltrate in patients receiving continuous venovenous hemofiltration with dialysis, with measurements of their catecholamine and hormonal content and calculation of continuous venovenous hemofiltration with dialysis clearances and daily extractions. Correlation of changes in catecholamines with prospectively collected hemodynamic data during the first 24 hrs of continuous venovenous hemofiltration with dialysis therapy. MEASUREMENTS AND MAIN RESULTS: No significant changes in dopamine, epinephrine, and norepinephrine requirements or plasma concentrations were seen during the first 24 hrs of continuous venovenous hemofiltration with dialysis. Overall daily losses of catecholamines in the ultradiafiltrate were small (dopamine 404 micrograms; epinephrine 32 micrograms; norepinephrine 29 micrograms). Hemodynamic variables remained stable during this period of continuous venovenous hemofiltration with dialysis therapy. All studied hormones were detected in the ultradiafiltrate, but their mean daily extractions were very small (aldosterone 0.37 micrograms; parathyroid hormone 53.4 pmol; cortisol 4.8 mg; T4 and T3 [trace amounts]; thyroid-stimulating hormone 2.6 mU; testosterone [trace amounts]). CONCLUSIONS: In critically ill patients with acute renal failure, continuous venovenous hemofiltration with dialysis results in minimal losses of catecholamines and is associated with cardiovascular stability. It causes only minor losses of several hormones. These losses are unlikely to be clinically important. Thus, blood purification achieved by continuous venovenous hemofiltration with dialysis does not produce significant catecholamine or hormonal losses and is associated with hemodynamic stability.

Acute Kidney Injury↗
PubMed1994

The 1-month outcome of patients with a low probability Technegas ventilation/perfusion lung scan.

The objective was to study the 1-month outcome of patients who had a low probability ventilation/perfusion lung scan using Technegas radioaerosol as the inhalational agent and who did not receive anticoagulation. One hundred consecutive patients with suspected pulmonary embolism were studied retrospectively. Their Technegas lung scans were classified by two blinded and independent nuclear medicine physicians and the medical records of all patients with a low probability scan were reviewed. One hundred inpatients (42 males and 58 females) with a mean age of 63 years were studied. The three most common clinical presentations leading to lung scintigraphy were unexplained dyspnoea (30 cases), unexplained dyspnoea with pleuritic chest pain (26 cases) and pleuritic chest pain only (15 cases). Nine patients had been judged by their managing medical team to have a high clinical probability of true pulmonary embolism, 32 had an intermediate probability clinical presentation and 59 a low clinical probability of pulmonary embolism. None of the 100 patients experienced further episodes of suspected or proven pulmonary embolism during the follow-up period. Six patients died. In none of them was pulmonary embolism either the cause of or a major contributing factor to death. The finding of a low probability scan using Technegas as the ventilation scintigram agent of choice describes a group of patients who, even in the absence of therapeutic anticoagulation, have a favourable 1-month outcome free of either true or suspected clinical pulmonary embolism. Invasive, pulmonary angiography-based diagnostic strategies may not be needed in this group of patients.

Female↗
PubMed1994

Asthma requiring mechanical ventilation. A low morbidity approach.

STUDY OBJECTIVE: There is considerable uncertainty about the clinical features, respiratory physiology, and optimal management of patients with asthma requiring mechanical ventilation. Furthermore, the ventilatory and pharmacologic management of asthma requiring mechanical ventilation remain controversial. We hypothesized (1) that there are clinically identifiable and pathophysiologically different subgroups presenting with asthma requiring ventilation; (2) that lower dose steroid therapy (< 400 mg/d intravenous hydrocortisone) is adequate; (3) that permissive hypercapnia is safe; (4) that prolonged paralysis is generally unnecessary; and (5) that clinical outcome would be favorable in patients treated with this approach. DESIGN: Review of medical records and intensive care charts and statistical analysis of findings. SETTING: ICU of tertiary institution. PATIENTS: Thirty-five consecutive cases of life-threatening asthma requiring mechanic ventilation. RESULTS: Three clinical subgroups of ventilation-requiring asthmatics could be identified. Those presenting with steady deterioration (10), those with unstable asthma followed by a sudden "dip" (16), and those with a sudden unexpected dip (9). Patients in the first group had a significantly lower PaCO2 (p < 0.01) at presentation, but required ventilation for longer periods. Those in the second group had a significantly higher PaCO2 (p < 0.01) and required ventilation for a shorter period. Those in the third group had an intermediate PaCO2 level before intubation and the shortest period (p < 0.01) of mechanical ventilation. Five patients experienced their sudden dip after ingesting aspirin. Ten cases received "high" dose hydrocortisone therapy (mean: 980 mg/24 h), and 25 received lower dose hydrocortisone (mean: 341 mg/24 h). No differences in illness severity at presentation or outcome could be detected between these two groups. Mean duration of ventilatory support was 36 h and mean duration of the ICU stay 52.1 h. Muscle relaxation was used in 12 patients for a mean period of 11.1 h. One patient was brain dead on arrival. All others survived. CONCLUSIONS: Life threatening asthma is an endpoint for several different clinical patterns of disease. No major clinical advantage could be found in our group of patients when high-dose steroids were used. Long-term use of muscle relaxants and prolonged mechanic ventilation are rarely needed in the management of patients with life-threatening asthma and excellent results can be achieved with a relatively simple management strategy.

Adult↗
PubMed1994

A prospective study of continuous hemodiafiltration in the management of severe acute renal failure in critically ill surgical patients.

Severe acute renal failure associated with surgical disease and a highly catabolic state poses a major therapeutic challenge. Treatment by conventional dialysis or arteriovenous hemofiltration suffers from serious shortcomings. The current study assesses the clinical and biochemical impact of a newer approach (continuous hemodiafiltration) in a cohort of 60 critically ill surgical patients with severe renal failure. All patients were studied prospectively and assessed for illness severity. Their biochemical response to therapy was analyzed and their clinical course to either death or hospital discharge documented. The use of continuous hemodiafiltration (CHD) permitted full control of azotemia in all patients (mean steady-state urea concentration: 19.8 mmol/L) and was associated with rapid control of acidemia (mean pretreatment pH: 7.27; mean ph after 24-h treatment: 7.35; p < .001). During the 15,696 h of therapy, there were no treatment-induced episodes of hypotension and/or hypoxemia. All patients were able to receive full-dose enteral (9) or parenteral (51) nutritional support with 1.5 to 2.5 g/kg/day of protein as tolerated. Despite their illness severity (mean APACHE II score: 28.9) and the need for vasopressor support and ventilation in 90% of cases, 21 patients (35%) survived to hospital discharge. We conclude that continuous hemodiafiltration is safe and effective in surgical critically ill patients with acute renal failure, and that it is associated with a low morbidity and an encouraging survival rate.

APACHE↗
PubMed1994

The outcome of critically ill elderly patients with severe acute renal failure treated by continuous hemodiafiltration.

OBJECTIVES: To study the outcome of critically ill elderly patients with severe acute renal failure managed by continuous hemodiafiltration. DESIGN: Prospective study. SETTING: Intensive Care Unit of tertiary institution PATIENTS: Seventy-two consecutive critically ill patients of 65 years or older admitted to the ICU with severe acute renal failure. Seventy similar control patients of age < 65 years. INTERVENTION: Treatment of all patients with continuous hemodiafiltration. MEASUREMENTS AND MAIN RESULTS: Safety and effectiveness of therapy were assessed. Main outcome measures were duration of oliguria, of ICU stay, and hospital stay for survivors, and survival to ICU discharge and to hospital discharge. Mean APACHE II score on admission was 29.8 (95% confidence interval: 28.5 to 31.1) and mean organ failure score prior to initiation of continuous hemodiafiltration was 3.9 (95% confidence interval: 3.6 to 4.2). Sepsis was present in 51 cases (70.8%) and bacteremia or fungemia in 24 (33.3%). Fifty-three (73.6%) required mechanical ventilation for > 3 days. Vasopressor drugs were used in 65 (90.2%). Continuous hemodiafiltration controlled azotemia in all patients and was only associated with minor complications. Thirty-four patients (47.2%) survived to ICU discharge and 30 (41.6%) to hospital discharge. Among survivors, duration of oliguria was 11.6 days (95% confidence interval: 9.1 to 14.1), mean duration of ICU stay 8.6 days (95% confidence interval: 6.1 to 11.) and mean duration of hospital stay 33.1 days (95% confidence interval: 28.8 to 37.4). No statistically significant difference in survival was found when these patients were compared to a control group of similar but younger patients who also received ICU care and continuous hemodiafiltration for the treatment of severe acute renal failure. CONCLUSIONS: A greater than 40% survival was achieved in critically ill elderly patients with severe acute renal failure by the use of continuous hemodiafiltration. These patients had an in hospital survival comparable to that of younger patients. These findings support an aggressive renal replacement approach in such patients and suggest that continuous hemodiafiltration may be ideally suited to their management.

Acute Kidney Injury↗
PubMed1993

Human melanoma cells express a functional interleukin-2 receptor.

Flow cytometric analysis reveals that 5 human melanoma cell lines (M14, IGR3, ME1477, JUSO, GLL19) express both alpha and beta chain of the interleukin 2 receptor (IL-2R alpha and IL-2R beta). These chains are able to specifically bind IL-2 and to form high-affinity heterodimers (IL-2R alpha beta). Analysis of poly A+ RNAs by Northern blot reveals the presence of typical transcripts for both the IL-2R alpha gene (3.6 kb) and the IL-2R beta gene (4 kb). Reverse transcription/polymerase chain reaction analysis allowed transcripts for the IL2R gamma (p64) gene to be detected in 3 of these melanoma cell lines (M14, IGR3, ME 1477). Incubation with human recombinant IL-2 modifies in IL-2R alpha+beta+gamma+ (M14) the expression of several surface molecules: down-regulation of ICAM-1, HLA class I and HLA-DR and up-regulation of CD44. IL-2 is also active on IL-2 alpha+beta+gamma- cell lines since it decreases ICAM-1 and HLA class-II expression at the surface of JUSO cells. Down-regulation of ICAM-1, whose expression in melanoma cells is a marker of tumor progression, is detectable within 3 hr in M14 cells and is maximal after 48 hr incubation, at IL-2 concentrations corresponding to the high-affinity heterodimers. This feature is specific since it is partially inhibited by MAbs directed against the IL-2 binding site of the IL-2R alpha (MAR93, 10T14) and IL-2R beta (MiK beta 1, TU27) chains. Our data support the notion of a direct effect of IL-2 on human melanoma cells. Modulation of the expression of surface molecules which is important for the interaction with immunocompetent cells or for tumor progression, could have a role to play during in vivo IL-2 treatment of human melanomas.

Antigens, Neoplasm↗
PubMed1993

[Case histories of extranodal non-Hodgkin's lymphomas with primary gastrointestinal appearance].

Authors refer results obtained in 24 cases of primary NHL of gastrointestinal tract. These cases were observed in the period 1981-1990. All cases can be included as primary extranodal lymphomas satisfying criteria of the literature. Sixty-six per cent (16/24) had a gastric localization half cases were centrocytic-centroblastic lymphomas followed by immunoblastic, centroblastic, follicular centrocytic-centroblastic and lymphocytic-well-differentiated. In intestinal localisation (34% of cases), the most represented was lymphocytic poor-differentiated, followed by mixed centrocytic lymphoma. Therapeutic strategy was: surgery in all patients followed by chemotherapy (CHOP 14/24) or by radiotherapy plus chemotherapy (8/24). Surgery alone was adopted in 2 out 24 patients. Patients who received radiotherapy plus chemotherapy had a sandwich treatment (CVP = 4/8, CHOP = 4/8) consisting of splint course of 3 cycles followed by radiotherapy and completed with other 3 drugs cycles. Sixteen out 24 patients were valuable (4 patients were lost during the follow-up due to problems other than the disease; 4 patients are still under treatment). In the 16 valuable patients we had a complete remission (CR) with a median free-disease survival of 82 months (range: 12-116 months) by means of the primary treatment. Four out 16 patients relapsed. In these patients the free-disease survival was range 8-108 months. All patients reached a second CR by means of chemotherapy (CCNU + VIP16) or radiotherapy. No cases of second tumor insorgence was observed.

Adult↗
PubMed1993

Anticoagulant regimens in acute continuous hemodiafiltration: a comparative study.

OBJECTIVE: To compare and contrast different heparin regimens for extracorporeal circuit anticoagulation in patients receiving acute continuous hemodiafiltration (ACHD). DESIGN: Prospective controlled randomized comparisons of the following regimens: 1) Low dose (500 IU/h) pre-filter heparin versus regional anticoagulation in patients on continuous arteriovenous hemodiafiltration (CAVHD) via A-V shunt. 2) Low dose pre-filter heparin versus no anticoagulation in patients receiving CAVHD via femoral cannulae. 3) Low dose pre-filter heparin versus regional anticoagulation in patients on continuous veno-venous hemodiafiltration (CVVHD). 4) An assessment of the consequences of the use of no anticoagulant in patients predicted to be at high risk of hemorrhagic complications on treatment with CVVHD. SETTING: University Teaching Hospital ICU. PATIENTS: 64 ICU patients with acute renal failure. MEASUREMENTS AND MAIN RESULTS: Haemofilter survival during shunt CAVHD was significantly prolonged by the use of regional anticoagulation compared to the use of low dose heparin (mean filter survival: 57.1 h versus 42.9 h; p < 0.05). In CAVHD using femoral cannulae, no significant differences in haemofilter survival were found between anticoagulation with low dose heparin and the use of no anticoagulant (mean filter survival: 55 h versus 52.5 h; NS). During CVVHD, regional anticoagulation compared to low dose heparin produced a trend towards prolonged filter life which was, however, not statistically significant (mean filter survival: 40.5 h versus 31.4 h; NS). In patients assessed to be at high risk of bleeding, CVVHD without anticoagulation provided a mean filter survival of 40.9 h (95% CI 27-54.8 h). CONCLUSIONS: Regional anticoagulation leads to longer filter survival than low dose heparin in shunt CAVHD. A regimen of no anticoagulation during femoral CAVHD leads to a filter life similar to that of low dose heparinization. During CVVHD, regional anticoagulation and low dose heparin are associated with similar filter survival times. In patients assessed to be at high risk of bleeding, treatment with CVVHD without anticoagulation results in adequate filter survival.

Acute Kidney Injury↗
PubMed1993

Acute renal failure in the critically ill: management by continuous veno-venous hemodiafiltration.

The consequences of newer techniques of continuous renal replacement therapy in critically ill patients are not yet fully known. The clinical and biochemical impact of continuous veno-venous hemodiafiltration (CVVHD) was, therefore, prospectively studied in 60 critically ill patients with acute renal failure. Prospective clinical, biochemical, and hematological data were collected from patients receiving CVVHD. Over the initial 24 hours of therapy, CVVHD resulted in a decrease in mean plasma urea from 34.5 mmol/L (95% confidence interval [CI], 29.4 to 39.6) to 25 mmol/L (95% CI, 21.8 to 28.2). With continued CVVHD, the mean plasma urea reached a plateau level of 17.6 mmol/L (95% CI, 15.8 to 19.4) at 72 hours. This degree of azotemia control was achieved with ease and essentially without complications during 8,360 hours of therapy despite the presence of multi-organ failure and the aggressive administration of protein nitrogen (0.25 to 0.35 g/kg/day). No abnormalities of serum electrolytes developed during treatment. Survival to intensive care discharge was 46.6% and to hospital discharge 41.6%, despite a mean Acute Physiology and Chronic Health Evaluation (APACHE) II score at presentation of 27.7. Continuous veno-venous hemodiafiltration offers superior azotemia control and a safe approach to renal replacement therapy in critically ill patients. Its use is associated with a comparatively favorable outcome. CVVHD may be regarded as the treatment of choice in such patients.

Acute Kidney Injury↗
PubMed1993

A prospective comparative study of continuous arteriovenous hemodiafiltration and continuous venovenous hemodiafiltration in critically ill patients.

We have prospectively studied and compared two consecutive groups of critically ill patients treated with either continuous arteriovenous hemodiafiltration (CAVHD) (n = 28) or continuous venovenous hemodiafiltration (CVVHD) (n = 25) to establish the technique of choice. The two groups were comparable in mean age (59 v 58 years), mean Acute Physiology and Chronic Health Evaluation (APACHE) II score (29.6 v 27.4, P = NS), requirements for inotropic drugs, and mean number of failing organs (2.9 v 3.2). CVVHD led to a greater amount of hourly ultrafiltrate (mean, 590 v 424 mL; P < 0.001), but urea and creatinine clearances were not significantly different with the two techniques. Twelve patients survived in the CAVHD group (42.8%) and 13 in the CVVHD group (52%; P = NS). The major advantage for CVVHD use was the substantial decrease in the number of access-related complications (2 v 10; P < 0.025). We conclude that while CVVHD does not offer a significant increase in solute clearance, it significantly minimizes vascular access-related morbidity and should therefore be regarded as the therapeutic modality of choice.

Chi-Square Distribution↗
PubMed1993

Acute continuous hemodiafiltration: a prospective study of 110 patients and a review of the literature.

One hundred ten critically ill patients with acute renal failure receiving acute continuous hemodiafiltration (ACHD) in our intensive care unit were studied prospectively. Acute continuous hemodiafiltration consisted either of continuous arteriovenous hemodiafiltration or of continuous veno-venous hemodiafiltration, and was used for 17,817 hours (mean duration of patient treatment, 161.9 hours), resulting in a fall from a mean pre-ACHD urea of 35.7 mmol/L to a plateau value of 16.8 mmol/L at 72 hours of treatment. The mean urea clearance achieved was 24.9 mL/min. Eighty of these patients (72.7%) were receiving artificial ventilation at the time of ACHD and 45 (40.9%) had more than four failing organs. The mean APACHE II score was 27.7. Despite the degree of illness severity, 42 patients (32.2%) survived to discharge from hospital. The use of ACHD was associated with hemodynamic stability, rapid normalization of electrolytes, and the ability to freely administer drugs, blood, and/or blood products. It also allowed for maintenance of an aggressive, nitrogen-rich, nutritional regimen. Support of these critically ill patients with acute renal failure using ACHD was achieved safely and without the employment of additional dialysis-trained nursing staff. Our own experience and a review of the available literature strongly suggest that the advantages associated with the use of ACHD therapies are clinically significant and support the view that ACHD is a modality of renal replacement most suited to critically ill patients with acute renal failure.

Acute Kidney Injury↗
PubMed1993

Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients.

OBJECTIVE: To determine whether continuous veno-venous hemofiltration with dialysis leads to extraction of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) from the circulation of critically ill patients with sepsis and acute renal failure and to quantitate the clearance and removal rates of these cytokines and their effect on serum cytokine concentrations. DESIGN: Prospective, controlled study of TNF-alpha IL-1 beta extraction by continuous veno-venous hemofiltration with dialysis in patients with septic acute renal failure. SETTING: Intensive care unit of a tertiary institution. PATIENTS: Eighteen critically ill patients with sepsis and acute renal failure. Control group of six patients experiencing an acute illness while undergoing chronic hemodialysis. INTERVENTIONS: Collection of blood samples before continuous veno-venous hemofiltration with hemodialysis. Simultaneous collection of prefilter blood and ultradiafiltrate after 4 and 24 hrs of treatment. MEASUREMENTS AND MAIN RESULTS: TNF-alpha and IL-1 beta concentrations were measured in blood and ultradiafiltrate. Their clearances and daily extraction were calculated and compared with a control group. TNF-alpha was detected in 66.6% of serum samples of patients with septic acute renal failure; IL-1 beta was detected in 55% of patients' sera samples. Both TNF-alpha and IL-1 beta were cleared by the hemofilter during continuous veno-venous hemofiltration with dialysis. The mean clearance for TNF-alpha was 30.7 L/day (95% confidence interval 22.4 to 39) with a daily mean excretion of 14.1 micrograms (95% confidence interval 1.7 to 26.5). Mean IL-1 beta clearance was 36.1 L/day (95% confidence interval 25.4 to 46.8) equivalent to a mean daily IL-1 beta excretion of 1 microgram (95% confidence interval 0.9 to 1.1). No measurable concentrations of TNF-alpha or IL-1 beta were found in the serum or ultrafiltrate specimens of control patients. CONCLUSIONS: These findings demonstrate that continuous veno-venous hemofiltration with dialysis can remove both TNF-alpha and IL-1 beta from the circulation of septic, critically ill patients. This cytokine extraction may prove to be of benefit in attenuating the progression of multiple organ dysfunction in patients with sepsis-associated renal failure, who are receiving continuous veno-venous hemofiltration with dialysis. This potential benefit of existing hemofiltration therapies supports their preferential implementation in patients with renal failure associated with severe sepsis. These observations may stimulate the modification of filtration membrane design seeking to specifically augment the clearance from the circulation of a variety of such cytokines.

Acute Kidney Injury↗
PubMed1993

A comparison of conventional dialytic therapy and acute continuous hemodiafiltration in the management of acute renal failure in the critically ill.

OBJECTIVE: To compare and contrast the clinical outcomes in critically ill patients with acute renal failure managed with either acute continuous hemodiafiltration or conventional dialytic therapies. DESIGN: Retrospective review of the medical records of 167 consecutive cases of acute renal failure treated at a single center (July 1982-July 1991). Scoring for illness severity (APACHE II, number of failing organs) and assessment of outcome in terms of biochemical control of azotemia, ARF therapy-related morbidity, and overall morbidity and mortality. SETTING: Tertiary institution. PATIENTS: 167 consecutive critically ill patients with multiorgan failure and acute renal failure. MEASUREMENTS AND MAIN RESULTS: 84 patients received conventional dialytic therapy (CDT) (1982-1988) and 83 acute continuous hemodiafiltration (ACHD) (1988-1991). The etiology of ARF and illness severity indices were similar in both groups (organ failure scores: CDT 3.9 vs. ACHD 4.1; NS). All patients were critically ill, with more severely ill patients within the ACHD groups (mean APACHE II score: CDT 25.8 vs. ACHD 28.1; p < .01). There were no significant differences in pretreatment serum creatinine, glucose, bicarbonate and phosphate, white cell and platelet counts, incidence of disseminated intravascular coagulation, prevalence of sepsis, or evidence of pulmonary and/or peripheral edema. Overall survival was 29.8% for the CDT groups and 41% for the ACHD group (NS). When patients were stratified by severity of illness, survival in those with 2 to 4 failing organs was significantly greater in the ACHD group (CDT 31.1% vs. ACHD 53.8%; p < .025). Similarly, overall survival in patients with intermediate APACHE II scores (24 to 29) was significantly better in those treated with ACHD (CDT 12.5% vs. ACHD 46.4%; p < .025). During the course of ARF, in comparison to CDT, ACHD was associated with greater overall reductions in serum creatinine, and in phosphate and plasma urea, and an increased net nutritional intake. CONCLUSIONS: ACHD provided biochemical and outcome indicator advantages over conventional dialytic therapy. In patients with 2 to 4 failing organs or an intermediate APACHE II score (24 to 29) a significant survival advantage was demonstrated for ACHD over CDT. Although this study is a retrospective analysis, with all the inherent limitations of such studies, it suggests that ACHD is the treatment of choice for ARF in the critically ill, with maximum benefits seen in those with 2 to 4 failing organs and/or intermediate APACHE II scores.

Acute Kidney Injury↗