Pulmonary Transplant After More Than 1 Year of Continuous Ambulatory Extracorporeal Support

Extracorporeal lung assist (ELA) has been recommended for the treatment of ARDS if conventional therapy fails. However, the need for nearly complete anticoagulation is a major risk factor for hemorrhagic complications. We describe our experience with 13 ARDS patients treated with ELA using heparin-coated systems (Carmeda). Maintaining partial thromboplastin time and activated clotting time within or close to the normal range, even major surgery (20 thoracotomies and 2 laparotomies) could be performed without undue bleeding complications related to anticoagulation during extracorporeal support. Eight of the 13 patients survived. The use of heparin-coated systems allows prolonged ELA with nearly physiological coagulation function, permitting major surgical intervention. It enhances the safety margin of extracorporeal gas exchange and may ultimately extend its indications.

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Extracorporeal Support of Gas Exchange

Oxygen Transport in the Critically Ill Patient ◽

10.1007/978-3-642-75646-7_6 ◽

1990 ◽

pp. 45-47

Author(s):

L. Gattinoni ◽

A. Presenti ◽

G. P. Rossi ◽

R. Fumagalli ◽

M. Bombino ◽

...

Keyword(s):

Gas Exchange ◽

Extracorporeal Support

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Evaluation of plasma levels of meropenem in septic patients during extracorporeal blood purification

Medical academic journal ◽

10.17816/maj54636 ◽

2021 ◽

Vol 20 (4) ◽

pp. 81-94

Author(s):

Artem V. Marukhov ◽

Elena V. Murzina ◽

Mikhail V. Zakharov ◽

Genrikh A. Sofronov ◽

Lyudmila V. Buryakova ◽

...

Keyword(s):

Septic Shock ◽

Critically Ill ◽

Critically Ill Patients ◽

Selective Adsorption ◽

Plasma Concentrations ◽

Blood Purification ◽

Continuous Hemodiafiltration ◽

Extracorporeal Blood ◽

Extracorporeal Blood Purification ◽

Extracorporeal Support

The relevance. Meropenem is a broad-spectrum carbapenem antibiotic widely used to treat patients with sepsis / septic shock. Critically ill patients are usually supported with one of the forms extracorporeal blood purification. However, data on the effect of various extracorporeal support techniques on the pharmacokinetics and pharmacodynamics of meropenem are insufficient or contradictory. Aim: To evaluate the effectiveness of meropenem dosage regimens in the treatment of septic patients during extracorporeal blood purification. Materials and methods. Plasma concentrations of meropenem were monitored in three critically ill patients with sepsis or septic shock. Patients were treated using various extracorporeal support techniques. Meropenem was used as empirical antibacterial mono- or complex therapy (1 g every 8 or 12 hours). Meropenem concentrations in plasma were determined by validated assay methods on Acquity ultraefficient liquid chromatography (UPLC) H-Class system. Results. It is shown that the meropenem plasma concentration in critically ill patients changes significantly. It was found that the standard meropenem dosing regimens in patients with sepsis / septic shock during continuous hemodiafiltration do not ensure the achievement of the PK/PD target of 100% TMIC for sensitive strains (MIC2 mg/L) and for intermediate resistance pathogens (2MIC8 mg/L). Continuous hemofiltration and selective adsorption of lipopolysaccharide have a less pronounced effect on the clearance of meropenem. Conclusion. To increase the effectiveness of antibacterial therapy, it is necessary to conduct research aimed at developing protocols for dosing antibacterial drugs for the treatment of sepsis during extracorporeal blood purification.

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Extracorporeal Support in Acute Respiratory Failure

Update in Intensive Care and Emergency Medicine - Update 1987 ◽

10.1007/978-3-642-83042-6_31 ◽

1987 ◽

pp. 253-259

Author(s):

A. Pesenti ◽

L. Gattinoni ◽

B. Coffano

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Extracorporeal Support

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