Multiple-Organ Extracorporeal Support Therapies in Critically Ill Patients  

作　　者：José Lucas Daza María C. Correcha Ferro Andrés David Cardenas Luis Daza Emilio Rey Jonathan de Jong John Galindo Gerardo Gutiérrez Luis Puello Yaroslad de la Cruz José Lucas Daza;María C. Correcha Ferro;Andrés David Cardenas;Luis Daza;Emilio Rey;Jonathan de Jong;John Galindo;Gerardo Gutiérrez;Luis Puello;Yaroslad de la Cruz(Nephrology Unit, Hospital De Clinicas, Buenos Aires, Argentina;Department of Medicine, Manizales University, Manizales, Colombia;Department of Medicine, Cooperativa University, Ibague, Colombia;Hematolology Unit, Fluminense University, Rio de Janeiro, Brasil;Nephrology Unit, Fresenius Medical Care, Ibague, Colombia)

机构地区：[1]Nephrology Unit, Hospital De Clinicas, Buenos Aires, Argentina [2]Department of Medicine, Manizales University, Manizales, Colombia [3]Department of Medicine, Cooperativa University, Ibague, Colombia [4]Hematolology Unit, Fluminense University, Rio de Janeiro, Brasil [5]Nephrology Unit, Fresenius Medical Care, Ibague, Colombia

出　　处：《Open Journal of Nephrology》2021年第2期281-293,共13页肾脏病（英文）

摘　　要：The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO₂, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus^®) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO₂, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus^®) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.

关 键 词：MODS (Multiple Organ Dysfunction Syndrome) RRT (Renal Replacement Therapy CRRT (Continuous Renal Replacement Therapy) SLED (Slow Efficiency Dialysis ECMO (Extracorporeal Membrane Oxygenation) ECCO2 (Extracorporeal Elimination of Carbon Dioxide) ARDS (Acute Respiratory Distress Syndrome) AKI (Acute Kidney Injury) 

分 类 号：R57[医药卫生—消化系统]