Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure
Abstract Background Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS mu...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00714-3 |
| _version_ | 1811341492735705088 |
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| author | Valentin Fuhrmann Theresa Weber Kevin Roedl Jasmin Motaabbed Adel Tariparast Dominik Jarczak Aritz Perez Ruiz de Garibay Johannes Kluwe Olaf Boenisch Harald Herkner John A. Kellum Stefan Kluge |
| author_facet | Valentin Fuhrmann Theresa Weber Kevin Roedl Jasmin Motaabbed Adel Tariparast Dominik Jarczak Aritz Perez Ruiz de Garibay Johannes Kluwe Olaf Boenisch Harald Herkner John A. Kellum Stefan Kluge |
| author_sort | Valentin Fuhrmann |
| collection | DOAJ |
| description | Abstract Background Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid–base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF. Methods 34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acid–base regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2). Results Median number of treatment sessions was 2 (range 1–9) per patient. Median duration of treatment was 17.5 (IQR 11–23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO3 − and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3 − and PaCO2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively. Conclusions In this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid–base disequilibrium. No major adverse events associated with the ADVOS treatments were observed. |
| first_indexed | 2024-04-13T18:56:05Z |
| format | Article |
| id | doaj.art-17b2b7f10bac417e92d066c285cc5d74 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-13T18:56:05Z |
| publishDate | 2020-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-17b2b7f10bac417e92d066c285cc5d742022-12-22T02:34:14ZengSpringerOpenAnnals of Intensive Care2110-58202020-07-0110111010.1186/s13613-020-00714-3Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failureValentin Fuhrmann0Theresa Weber1Kevin Roedl2Jasmin Motaabbed3Adel Tariparast4Dominik Jarczak5Aritz Perez Ruiz de Garibay6Johannes Kluwe7Olaf Boenisch8Harald Herkner9John A. Kellum10Stefan Kluge11Department of Intensive Care Medicine, University Medical Center Hamburg-EppendorfDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfDepartment of Medicine B, University MünsterDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfUniversity of Strasbourg, CNRS, Immunopathology and Therapeutic ChemistryDepartment of Internal Medicine 1, University Medical Center Hamburg-EppendorfDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfDepartment of Emergency Medicine, Medical University ViennaDepartment of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh Medical CenterDepartment of Intensive Care Medicine, University Medical Center Hamburg-EppendorfAbstract Background Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid–base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF. Methods 34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acid–base regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2). Results Median number of treatment sessions was 2 (range 1–9) per patient. Median duration of treatment was 17.5 (IQR 11–23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO3 − and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3 − and PaCO2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively. Conclusions In this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid–base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.http://link.springer.com/article/10.1186/s13613-020-00714-3Multiple organ failureExtracorporeal organ supportAlbumin dialysisAcute liver failureAcidosisARDS |
| spellingShingle | Valentin Fuhrmann Theresa Weber Kevin Roedl Jasmin Motaabbed Adel Tariparast Dominik Jarczak Aritz Perez Ruiz de Garibay Johannes Kluwe Olaf Boenisch Harald Herkner John A. Kellum Stefan Kluge Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure Annals of Intensive Care Multiple organ failure Extracorporeal organ support Albumin dialysis Acute liver failure Acidosis ARDS |
| title | Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure |
| title_full | Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure |
| title_fullStr | Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure |
| title_full_unstemmed | Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure |
| title_short | Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure |
| title_sort | advanced organ support advos in the critically ill first clinical experience in patients with multiple organ failure |
| topic | Multiple organ failure Extracorporeal organ support Albumin dialysis Acute liver failure Acidosis ARDS |
| url | http://link.springer.com/article/10.1186/s13613-020-00714-3 |
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