Đánh giá hiệu quả lọc máu hấp phụ cytokin trong điều trị bệnh nhân covid-19

TÓM TẮT Đặt vấn đề: Lọc máu hấp phụ được xem là một phương pháp điều trị ở bệnh nhân Covid-19 nặng do có khả năng loại bỏ cytokine viêm. Nghiên cứu này mục đích để đánh giá hiệu quả lọc máu hấp phụ theo phương thức lọc máu ngắt quãng (IHD) ở bệnh nhân Covid-19. Phương pháp nghiên cứu: Nghiên cứu can thiệp, thực hiện trên các bệnh nhân được chẩn đoán viêm phổi do Covid-19 mức độ nặng ở trung tâm hồi sức tích cực bệnh viện dã chiến số 14, thành phố Hồ Chí Minh. Bệnh nhân được điều trị với thuốc kháng virus, kháng sinh, kháng đông và corticoid và liệu pháp oxy và 3 lần lọc máu hấp phụ sử dụng máy lọc máu ngắt quãng. Các chỉ số lâm sàng và xét nghiệm được thu thập và so sánh ở thời điểm trước và sau lọc máu. Kết quả: Có 6 bệnh nhân nam và 4 bệnh nhân nữ ở độ tuổi trung bình 54,60 ± 14,00 điều trị lọc máu hấp phụ, có 7 bệnh nhân cải thiện và cai dần với liệu pháp oxy. Giá trị SpO2 tăng từ 92,00 ± 2,31% đến 94,40 ± 1,71% với p = 0,02. IL - 6 trong máu bệnh nhân giảm từ 110,80 ± 126,84 pg/mL xuống 26,55 ± 26,80 pg/ mL với p = 0,06, CRP giảm từ 139,90 ± 57,41mg/L xuống 56,10 ± 53,10mg/L với p = 0,03. Kết luận: Lọc máu hấp phụ có thể giúp cải thiện SpO2 và hỗ trợ cai liệu pháp oxy ở hầu hết bệnh nhân trong nhóm nghiên cứu. Tuy nhiên, trong tương lai cần có nghiên cứu đa trung tâm, có đối chứng trên nhiều bệnh nhân để có thể đánh giá chắc chắn hiệu quả lọc máu hấp phụ ở bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF HEMOPERFUSION IN COID-19 PATIENTS Backgrounds: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. This study aims to evaluate the effectiveness of hemoperfusion in coid-19 patients. Methods: This experimental research has been conducted on severe COVID-19 pneumonia patients who admitted in field hospital in Ho Chi Minh city, receiving antiviral, antibacterial drugs, anticoagulant drugs and steroid, and different modalities of respiratory treatments. No randomization and blindness were considered. All of the participants underwent three sessions of resin-directed hemoperfusion using intermittent hemodialysis machine. Results: Six men and four women with a mean age of 54.60 ± 14.00 years has been enrolled in the study, and seven of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after cytokine removal therapy. Mean SpO2 before the three session of hemoperfusion was 92.00 ± 2.31% and increased to 94.40 ± 1.71% after them (p = 0.02). Serum IL - 6 showed a reduction from 110.80 ± 126.84 pg/mL to 26.55 ± 26.80 pg/mL p = 0.06; and C-reactive protein decreased from 139.90 ± 57.41mg/L to 56.10 ± 53.10mg/L p = 0.03. Conclusions: Extracorporeal hemoadsorption using intermittent dialyisis machine could improve the general condition in most of recruited patients with severe coronavirus disease, however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. Keywords: Intermittent dialyisis machine, hemoperfusion, COVID-19 pneumonia.

Protocol for local on-site dialysate production for continuous renal replacement therapy during the COVID-19 pandemic

Acute kidney injury frequently occurs in patients with COVID-19 and injury severe enough to require renal replacement therapy (RRT) is a common complication among critically-ill patients.[1-3] During the surge, there was a high demand for dialysate for continuous RRT, and this increase in demand coupled with vulnerabilities in the supply chain necessitated alternative approaches, including internal production of dialysate. Using a standard hemodialysis machine and off the shelf supplies as per Federal Drug Administration (FDA) guidelines, we developed a method for on-site dialysate production that is adaptable and can be used to fill multiple bags at once. The use of a central reverse osmosis unit, dedicated hemodialysis machine, sterile bags with separate ports for fill and use, and frequent testing will ensure stability, sterility and therefore safety of produced dialysate. Dialysate made in house was tested and showed both stability and sterility for at least 30 hours. This detailed description of our process for generating dialysate can serve as a guide for other programs experiencing similar vulnerabilities in the demand vs. supply of dialysate.

MO781THE CATIONIC CELLULOSE BASED PAD REDUCE THE HEMOSTATIC TIME AFTER HEMODIALYSIS

Background and Aims In case of prolonged bleeding at the vascular access site after hemodialysis, a nurse must compress the bleeding site longer than usual. This situation causes the risk of intravascular thrombosis and consumes valuable time of both patients and staff. Therefore, effective hemostatic agents are desired. Nowadays, chitosan is considered as one of the strongest hemostatic substance. Nipro Corporation and Artisan-lab co., Ltd found the cationic cellulose could clot blood faster than chitosan in the activated clotting time (Figure). After carefully examining its safety and efficacy, it was approved as medicine by the Japanese Ministry of Health, Labor and Welfare. Then, a trial to verify its clinical efficacy as a hemostat was conducted in the Toshin Clinic. In our clinic, the timer is set on the hemodialysis machine after the needles are removed and pressure is started after hemodialysis. We examined how long the timer should be set to be able to sufficiently stop bleeding in case cationic-cellulose pads are used. Method Of the 150 hemodialysis patients treated at the Toshin clinic; patients who agreed to this trial were enrolled. We set a timer for 5 minutes initially using cationic-cellulose pads for hemostasis, and was shortened in the next trial by 1 minute if the bleeding had been stopped. If the patient did not consent, the timer was not shortened further. from April 15th to December 31st in 2020. We checked the bleeding evidence of the puncture sites at the timing of immediately after relieving their compression. At their following hemodialysis session, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection. Results Ten patients (9 men and 1 woman, Age 58.5y ±13.1) agreed to participate in this study. In the case of stable hemostasis, we continued to shorten the time by 1 minute each time, and added 1 minute in case of bleeding. After searching for the shortest time to achieve stable hemostasis, we confirmed hemostasis an average of 14.2 times in all cases. The average time to set for the timer was 3.0 ± 0.94 minutes (2-5 minutes). Two patients refused to shorten the time set for the timer, the hemostasis time were 5 and 4minutes respectively. The hemostasis time in all the other cases was equal or less than 3 minutes. In one case, the hemostasis time was reduced to 3 minutes with a cationic cellulose pad, compared to 30 minutes with The Neoplaster hemostatic pad (Nipro Corporation) which is made with the carboxymethyl cellulose. Of the 142 case compressions performed, 1 case resulted in bleeding and required 2 minutes of additional compressions. All cases did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites. Discussion This study showed that the average time to set for the timer, when using cationic cellulose pad was 3 minutes on average, without any adverse effects. Cationic cellulose pads can stop bleeding safely, quickly and stably. At present, clinically available strong hemostatic agents are too expensive to be applied for many patients. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough to be distributed to many hemodialysis patients because this material is mass-produced for hair conditioner, shampoo, and toothpaste. Conclusion The average time set for the timer was estimated around 3 minutes using the cationic cellulose pad. The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis.

A Proof-of-Principle Study of the Design and Optimization of a Novel Fluid-Driven Automated Retracting Needle System

The cannulation of blood vessels is one of the most basic and essential interventions in medical practice. A common adverse event of this procedure is miscannulation with infiltration of the second part of the vessel wall, often resulting in a perivascular hematoma. In hemodialysis patients, surgically created arteriovenous conduits are cannulated 3–4 times per week to provide sufficient blood supply to the hemodialysis machine. However, the high blood flow and pressure in these vascular access sites increase the risk of complications upon miscannulation. A novel needle system that allows for rapid automatic retraction of the needle in response to contact with blood after positioning the cannula in the blood vessel was developed to reduce the risk of miscannulation. The device can easily be incorporated into existing needle designs. The mechanical functionality of the device was validated by testing prototypes in an ex vivo system. Optimization of the needle system was performed to enhance response time and piston shape. A final prototype design was manufactured and validated. The optimal membrane composition and piston shape were determined, which resulted in a needle response time of 40 ms upon contact with fluid at a pressure of 100 mmHg (arterial pressure). Here, we have successfully designed, mechanically validated, and tested a novel automated rapid needle retraction system that allows incorporation into existing needle systems. This device could notably decrease the difficulty of vessel cannulation and the prevalence of hematoma formation.

The Effect of Preparing Dialysis Machine Using Normal Saline-Heparin on the Dialysis Adequacy of Hemodialysis Patients: A Crossover, Two-Group, and Randomized Clinical Trial

Background: Patients with end-stage renal disease (ESRD) need adequate dialysis. Thus, identification of the ways to enhance dialysis adequacy is very important. Objectives: The present study was conducted to examine the effect of preparing a dialysis machine using a normal saline heparin method on the dialysis adequacy of hemodialysis patients. Methods: This study was conducted in Hamadan in 2019. A total of 36 patients with hemodialysis were selected using convenience sampling who were assigned to the control and intervention groups. The hemodialysis machine was primed for one month using a routine method (control) and one month using a normal saline-heparin method (intervention). Urea reduction ratio (URR) and Kt/V indices were calculated at the beginning and end of each month in the intervention and control groups. Data were analyzed using paired and independent t-test. Results: In the normal saline-heparin group, KT/V showed a statistically significant difference before and after the treatment (P = 0.013), as well as an increase in the KT/V. The URR as the mean dialysis adequacy showed a statistically significant difference (P = 0.004) between the normal saline group and the normal saline-heparin group before and after the treatment. Moreover, URR in the normal saline-heparin group increased after the treatment. In the normal saline treatment group, KT/V and URR decreased after the treatment. In the normal saline group, URR decreased after the treatment. Conclusions: Applying the hemodialysis machine preparation with a normal saline-heparin method increased dialysis adequacy in the patients who underwent hemodialysis.

Hemodialysis Minimal is the Future

Father of Hemodialysis, Willelm Kolff a Dutch physician, during the terrible times of Nazi occupation risked his life to experiment and invent the first hemodialysis machine. One can imagine, that the power to do something good for your fellow human beings does not wait for the perfect times and facilities.