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Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration
P D Yorgin1, D K Eklund, A al-Uzri
1Department of Pediatrics, University of Arizona, Steele Memorial Children's Research Center, Tucson 85724, USA. pyorgin@peds.arizona.edu
Pediatric Nephrology (Berlin, Germany)
|February 2, 2000
Summary
Continuous venovenous hemofiltration/hemodiafiltration (CVVH/D) combined with centrifugation plasmapheresis (P-CVVHD) is a feasible concurrent therapy. This novel technique offers potential advantages over separate treatments for critically ill patients requiring renal replacement and apheresis.
Area of Science:
- Nephrology
- Critical Care Medicine
- Blood Purification Technologies
Background:
- Continuous venovenous hemofiltration/hemodiafiltration (CVVH/D) is standard for hemodynamically unstable critically ill patients needing renal replacement therapy.
- Plasmapheresis is sometimes required for conditions like sepsis, fulminant hepatic failure, and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.
- Centrifugation plasmapheresis is preferred over membrane plasmapheresis in many centers for its versatility.
Observation:
- A new technique combining centrifugation plasmapheresis and continuous venovenous hemodiafiltration (P-CVVHD) was developed.
- The P-CVVHD technique was implemented using a Hospal BSM 22 machine with a Multiflow 60 hemofilter and a Cobe Spectra continuous cell separator in parallel.
- The combined therapy was used concurrently, allowing simultaneous blood filtration and plasmapheresis.
Findings:
- P-CVVHD is technically feasible and can be sustained for extended durations.
- The concurrent application of P-CVVHD demonstrated limited associated risks.
- The study suggests potential benefits of P-CVVHD over sequential or discontinuous combined therapies.
Implications:
- P-CVVHD represents a viable alternative for critically ill patients requiring both renal support and apheresis.
- This integrated approach may streamline treatment protocols and potentially improve patient outcomes.
- Further research is warranted to fully elucidate the advantages and optimal application of P-CVVHD.