1 / 28

CVVH in Europe

CVVH in Europe. CVVH in Europe. All Sorts of Trouble and Complications. CVVH Experience in Hannover 7-1997 to 3-2002. CVVH Machine. Solutions for Substitution. SH19* SH39 Hep*

serge
Download Presentation

CVVH in Europe

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CVVH in Europe CVVH in Europe

  2. All Sorts of Trouble and Complications • CVVH Experience • in Hannover • 7-1997 • to • 3-2002

  3. CVVH Machine

  4. Solutions for Substitution • SH19* SH39 Hep* • Na 140 145 mmol/l K 1 0 mmol/l Ca 1.63 1.55 mmol/l Mg 0.75 0.52 mmol/l Cl 100.75 113.64 mmol/l Lactate 45 - mmol/l Bicarbonate - 36 mmol/l Glucose 1.96 1.04 g/l • *Schiwa

  5. Patients • Patients 32 • Male/ Female 18 / 14 • Age* [years] 5.3 (2 days - 19) • Weight* [kg] 14.1 (3.3 - 88) • BSA [m2] 0.63 (0.22 - 1.97) • *median (range)

  6. Groups of Patients • Septicemia 12 • Liver failure 9 • Cardiac Disease 5 • Renal Disease 3 • Hyperammonemia 3

  7. Solutions for Substitution • Schiwa SH39-Hep N 24 • Schiwa SH 19 8

  8. Filters Used • Diafilter 20 20 • Minifilter plus 4 • Minifilter /D20 5 • Hemofilter 6S 3

  9. Blood and Dialysate Flow • Blood flow [ml/kg/min] 3.1 (0.6 - 17.2) • Exchange rate [ml/m2/h] 475 (189 -1505) • Negative balance [ml/kg/h] 4.2 (0 - 17)

  10. CAVH Urea 0 1 2 4 8

  11. Ultrafiltration

  12. Number Filters Used

  13. Filters clot 43/140 were lost this way (30.3%)

  14. Duration of CVVH and Filter Survival • Total duration of CVVH [h] 56.5 (3 - 422) • Number of filters 140 • „Survival“ of filter [h] 22.4 (0.5 - 87) • Reason for loss deliberate change 44 • of a filter clotting 43 • operation/ CT scan 16 • end of CVVH 27 • technical problems 5 • plasmapheresis 5

  15. Technical Problems • Switching between the 2 lines of the access 4 • Necessity to replace access 2 • 3 Lumen oncologic catheter (Clearance 11) 1

  16. Renal Disease (3/3) Severe Hypertension during recurrent HUS 1 Bilateral Nephrectomy during PD in an infant 1 ATN after renal Tx 1

  17. Hyperammonemia (1/3) • All 3 newborns received CVVHD • Defect CNS involvement Ammonia [µmol/l] • Citrullinemia mild encephalopathy 842 360 • Citrullinemia severe encephalopathy 802 223 • CPS def. cerebral edema 900 850

  18. Heart Disease (1/5) TGA with Rastelli operation, bradyarrhythmias 2 Bradyarrhythmias 1 Pulmonary atresia with interventional opening of the outflow tract 1 Penetrating heart trauma with a bicycle 1

  19. Liver Disease (3/9) • Liver transplantation (3 acute LF) 7 • Acute liver failure, no TX 2 • Complicating factors • Re-transplantation 2 • Portal vein thrombosis 2 • CNS symptoms (seizure, edema) 2 • Severe rejection (plasmapheresis) 1 • Destruction of liver and spleen (horse kick) 1

  20. Septicemia(4/12) • Bone MarrowTransplant 2 • Oncologic patient 2 • Heart/lungTx in CF, Liver Tx • Waterhouse-Friedrichsen Sy., Schwachman • Familial medit. Fever (amyloidosis) SCID • Premature with NEC Septic RF • 1 each

  21. Causes of Death • Multiple organ failure 8 • Circulatory failure 4 • Brain death 3 • Liver failure 2 • Rhabdomyolysis 2 • Complete bowel necrosis 1

  22. Major Complications • Arterial hypotension 15 / 32 • Bleeding 3 • Thrombosis iliac vein 1

  23. Stenosis of the Internal Jugular Vein Stenosis of Internal Jugular Vein

  24. CAVH Results

  25. Intensive Care and Dialysis • Total Death % • Cases in intensive care 938 35 4 • LTx 15 (24), NTx 18 (31) • ICU patients dialysed 24 2.5 • Dialysis 24 9 38 • CVVH 9 4 • PD 14 5 • HD 1 0

  26. Conclusion • CVVH broadens the array of treatment options in acute renal failure. It allows easier management through better fluid and solute clearances. • However, this does not appreciably improve survival. Still, the original disease determines the prognosis - with renal failure being an negative predictor.

More Related