ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
filter iCa every 6 hours when using the
UAB .5% dilute RCA protocol for
CVVHDF. Unless a patient has clotting
problems on CVVHDF, we recommend
post filter iCa can perhaps be changed
<strong>from</strong> every 6 hours to once a day
reducing not only complexity of citrate
use with CRRT but also decreasing labor
and cost.
68. Heparin Anticoagulation in
Powdered Sorbent Pheresis in
Septic ICU patients
RY Tan, HK Tan, CM Loo, CG Lim
Singapore General Hospital
Introduction: Severe sepsis is
associated with very high mortality. The
Intermittent Modular Plasma Adsorption
of Cytokines and Toxins (IMPACT)
(Hemolife Medical Inc) system was used
in these patients. We hypothesized that
an attenuated anticoagulation protocol
does not increase bleeding yet achieves
prescribed treatment time. Method:
IMPACT is based on coupled plasmafiltration
adsorption methodology with
three chemically distinct non-ionic,
powered sorbents. Intermittent 4 h
treatment sessions were instituted.
Systemic anticoagulation was with
unfractionated heparin following
heparin-saline prime. Results: A total of
5 patients (M:F=4:1; age 67±7; and,
APACHE II score 25±4) were
prospectively treated with 17 sessions of
IMPACT. Duration of ICU stay was
16±7 days. Circuit pressures pre- versus
post-IMPACT (mmHg): arterial pressure
(AP)-52±7 vs. -53±11, p=.778; venous
pressure (VP) 44±9 vs. 48±16, p=.342;
pre-sorbent column plasma pressure (PS)
92±8 vs. 133±78, p=.37; and pre-plasma
filter circuit pressure (PPF) 45±11 vs.
63±25, p=.12. Operating conditions
were: pumped blood flow rate QB 125±7
ml/min; plasma flow rate QP 2±9
ml/min; and, total heparin administered
was 2515±1481 IU per treatment. One
circuit spontaneously clotted during
treatment. IMPACT treatment time was
237±25 minutes per session.
Anticoagulation intensity pre- vs. post-
IMPACT was: ACT (s) 189±2 vs.
238±98 (target 25 s), p=.61, activated
partial thromboplastin time (aPTT)
65±57 vs. 12±63 s, p=.44, and platelet
count (x19/µL) 25±92 vs. 139±71,
p=.18. Overall, serum creatinine was
255±132 µmol/L. There were no major
bleeding episodes requiring invasive
hemostasis. Conclusion: Reduced
systemic heparin anticoagulation during
IMPACT did not increase bleeding but
was associated with a significant rise in
plasma filter and sorbent column plasma
pressures. Prescribed treatment time was
nevertheless still achieved.
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