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

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Blood Transfusions are Important for the Resuscitation of the Critically Ill Patient Educational Objectives: Can Ince PhD 11:00-11:15 Thursday, February 16 To explain the importance of red blood cells and their hemorheological factors which determine optimal delivery of red blood cells to the microcirculation. Explain the importance of convective and diffusive transport of oxygen and the importance of viscosity in this respect. To explain that hypovolemia can indeed be corrected by fluid resuscitation but that lowering the hematocrit can compromise the distribution and oxygen transport to the tissues. Content Description: When shock or hemodilution leads to a limitation in the oxygen carrying capacity of the circulation, blood transfusions are warranted. Blood transfusions are affective in transporting oxygen to the tissues. Not only because of improved oxygen carrying capacity due to the presence of haemoglobin, but because of its viscosity, important in recruiting the microcirculation. Red blood cells (RBC) also have an important role in vascular regulation. Recent studies have shown that in the presence of hypoxia RBCs release vasodilator substances such as nitric oxide and ATP. Various reports have indicated that storage of RBCs can have deleterious effects on their ability to transport oxygen to the tissues. Indeed recent clinical trials seem to corroborate these earlier findings. In animal studies we had shown that citrate based storage media could adversely affect the oxygen carrying properties of stored blood when transfused in vivo and that the use of more modern storage fluids such as SAGM did not suffer <strong>from</strong> such effects . It should be noted that recent trials reporting that transfusion of aged RBCs are associated with adverse clinical outcomes have used non-leuco-depleted stored blood. In clinical studies we have performed using SAG-M stored leuco-depeleted blood we have shown that blood transfusion in cardiac surgery and anaemic hemotological patients lead to improvement in red blood cell availability in the microcirculation and improvement in tissue oxygenation . Nevertheless maintaining physiological hematocrit and [Hb] by blood transfusions using leuco-depleted has been show in a recent German trial to lead to improved outcome, organ function and length of stay. These results suggest that when storage conditions are optimized, blood transfusions for increasing oxygen delivery to the tissues are an essential procedure in the hemodynamically compromised critically ill patient. Suggested Reading: Yuruk K, Bartels SA, Milstein DM, Bezemer R, Biemond BJ, Ince C. (2011) Red blood cell transfusions and tissue oxygenation in anemic hematology outpatients. Transfusion. Aug 29. doi: 10.1111/j.1537-2995.2011.03312.x Raat NJH, Ince C (2007) Oxygenating the microcirculation: the perspective <strong>from</strong> blood transfusion and blood storage. Vox Sanguin 93(1):12-8. Yuruk K, Almac E, Bezemer R, Goedhart P, de Mol B, Ince C (2010) Blood transfusions recruit the microcirculation during cardiac surgery. Transfusion 51(5):961-7. Raat NJ, Hilarius PM, Johannes T, de Korte D, Ince C, Verhoeven AJ. (2009) Rejuvenation of stored human red blood cells reverses the renal microvascular oxygenation deficit in an isovolemic transfusion model in rats. Transfusion 49(3):427-4. 37
Raat NJ, Verhoeven AJ, Mik EG, Gouwerok CW, Verhaar R P.T. Goedhart PT, de Korte D, Ince C (2005) The effect of storage time of human red cells on intestinal microcirculatory oxygenation in a rat isovolemic exchange model. Critical Care Med 33:39-45. Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA .269(23):3024-9. Gladwin MT, Shelhamer JH, Schechter AN, Pease-Fye ME, Waclawiw MA, Panza JA, Ognibene FP, Cannon RO (2000). Role of circulating nitrite and S-nitrosohemoglobin in the regulation of regional blood flow in humans. Proc Natl Acad Sci U S A. 10;97(21):11482-7. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, Blackstone EH (2008) Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 358:1229-39 . Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U, Barz D, Reinhart K. (2010) Anemia and blood transfusion in a surgical intensive care unit. Crit Care. 14(3):R92. Van Bommel J, de Korte D, Lind A, Siegemund M, Henny P, Ince C (2001) The effect of transfusion of stored red blood cells on intestinal microvascular oxygenation in a rat model Transfusion 41:1515-23. 38
Page 2 and 3: CRRT 2012 SEVENTEENTH INTERNATIONAL
Page 4 and 5: FACULTY DISCLOSURES CRRT 2012 Facul
Page 6 and 7: CRRT 2012 ORGANIZING COMMITTEE USA
Page 8 and 9: CRRT 2012 FACULTY Patrick Honoré,
Page 10 and 11: ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
Page 12 and 13: PLENARY SESSIONS CRRT 2012 PROGRAM/
Page 18 and 19: WORKSHOPS CRRT 2012 PROGRAM/INDEX T
Page 20 and 21: WORKSHOPS CRRT 2012 PROGRAM/INDEX W
Page 22 and 23: POSTER ABSTRACTS C
Page 24 and 25: POSTER ABSTRACTS C
Page 26 and 27: NURSING FORUM LUNCHEON Communicatio
Page 28 and 29: Nutritional Support in ICU Patients
Page 30 and 31: Educational Objectives: The Endothe
Page 32 and 33: SPECIAL LECTURE Engineering Critica
Page 34 and 35: Nishimura R, Ornato JP, Page RL, Ri
Page 36 and 37: Do Vasoactive Drugs and Fluids Impr
Page 40 and 41: Thinking Outside of the Box: A Nove
Page 42 and 43: Nursing Forum 2 Luncheon Benchmarki
Page 44 and 45: 4. Mori K, Lee HT, Rapoport D, Drex
Page 46 and 47: Differential Diagnosis of AKI: Can
Page 48 and 49: Myocardial Stunning and Brain Edema
Page 50 and 51: 4. Udy A, Roberts JA, Lipman J. Wha
Page 52 and 53: CRRT and ECMO: Techniques and Outco
Page 54 and 55: Management of Severe Heart Failure:
Page 56 and 57: Avoiding Anticoagulation for CRRT:
Page 58 and 59: Improving Outcomes from</st
Page 60 and 61: The Changing Face of AKI: Snapshots
Page 62 and 63: Alkaline Phosphatase Peter Pickkers
Page 64 and 65: creatinine (Cr) was measured using
Page 66 and 67: Surveillance and Early Recognition
Page 68 and 69: therapy admitted to general intensi
Page 70 and 71: A01 Assessing the Microcirculation
Page 72 and 73: A01 Assessing the Microcirculation
Page 74 and 75: C03 Critical Care Pharmacology: Vas
Page 76 and 77: D04 Biomarkers 1: Principles and Ap
Page 78 and 79: 6. Ferguson JW, Dover AR, Chia S, C
Page 80 and 81: G07 Fluids and Solutions in the Cri
Page 82 and 83: A09 Vascular Access /Membrane and C
Page 84 and 85: A09 Vascular Access /Membrane and C
Page 86 and 87: C11 Critical Care Management: Nutri
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D12 Biomarkers 2: Application in AK
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Educational Objectives: E13 Liver a
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G15 Fluids and Solutions in the Cri
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Educational Objectives: 1) Discuss
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B18 Fluid Management Ravindra L. Me
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C19 Acid Base and Electrolyte Probl
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D20 Extracorporeal Techniques for S
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the mediatordelivery hypothesis. In
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F22 Ensuring Patient Safety and Qua
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H24 Patient Centered Care in the IC
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B26 Starting and Stopping RRT for A
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C27 Acid Base and Electrolyte Probl
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D28 Extracorporeal Techniques for S
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E29 Heart Failure and Cardio-Renal
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F30 Ensuring Patient Safety and Qua
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H32 Withdrawing & Withholding Suppo
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Patel SS, Holley JL. Withholding an
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