Document Detail


Plasma exchange as rescue therapy in multiple organ failure including acute renal failure.
MedLine Citation:
PMID:  12794412     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the outcome of using a rescue therapy including plasma exchange given to patients with a progressive acute disseminated intravascular coagulation and multiple organ dysfunction syndrome. STUDY DESIGN: Retrospective study. SETTING: University and county hospital. PATIENTS: Included were 76 consecutive patients (41 men and 35 women) treated with plasma exchange as rescue therapy besides optimal conventional therapy during a progressive course of disseminated intravascular coagulation and multiple organ dysfunction syndrome, including acute renal failure. Of the 76 patients, 66% needed dialysis. The distribution was hemodialysis in 76%, continuous arteriovenous hemofiltration in 36%, continuous venovenous hemodialysis in 12%, and peritoneal dialysis in 24%. The median organ-failure score was 5 (range, 1-6). Seventy-two percent required mechanical ventilation; septic shock was present in 88%. The median septic shock score was 4 (range, 2-4). Nine patients had another reason than sepsis for the multiple organ dysfunction syndrome. INTERVENTION: Plasma exchange (centrifugation technique) was performed until disseminated intravascular coagulation was reversed (median, two times; range, 1-14). Besides antibiotics and fluid administration, most patients received heparin or low molecular weight heparin (77%), steroids (87%), and inotropes (88%). More than one vasoactive drug was used in 57% of the patients. MEASUREMENTS AND MAIN RESULTS: Eighty-two percent of the patients survived and could leave the hospital. The previously observed survival rates by others for this category of patients would be <20%, and thus, the outcome in this study is significantly better. CONCLUSION: Plasma exchange using plasma as replacement may, in addition to conventional intensive care, help to reverse severe progressive disseminated intravascular coagulation and multiple organ dysfunction syndrome and improve survival.
Authors:
Bernd G Stegmayr; Ravjet Banga; Lars Berggren; Rut Norda; Anders Rydvall; Tomas Vikerfors
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-09     Completed Date:  2003-07-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1730-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Nephrology, Department of Internal Medicine, Medicinkliniken, University Hospital, SE-901 85 Umea, Sweden. bernd.stegmayr@medicin.umu.se
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child, Preschool
Combined Modality Therapy
Disseminated Intravascular Coagulation / mortality,  therapy*
Female
Humans
Kidney Failure, Acute / therapy*
Male
Middle Aged
Multiple Organ Failure / etiology,  mortality,  therapy*
Plasma Exchange* / adverse effects
Renal Dialysis
Retrospective Studies
Sepsis / complications,  microbiology
Survival Rate
Sweden / epidemiology
Treatment Outcome
Comments/Corrections
Comment In:
Crit Care Med. 2003 Jun;31(6):1875-7   [PMID:  12794441 ]

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