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CVVH in Europe All Sorts of Trouble and Complications CVVH Experience in Hannover 7-1997 to 3-2002.

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Presentation on theme: "CVVH in Europe All Sorts of Trouble and Complications CVVH Experience in Hannover 7-1997 to 3-2002."— Presentation transcript:



3 CVVH in Europe

4 All Sorts of Trouble and Complications CVVH Experience in Hannover to

5 CVVH Machine

6 Solutions for Substitution SH19*SH39 Hep* Na140145mmol/l K10 mmol/lCa mmol/lMg mmol/l Cl mmol/lLactate45- mmol/lBicarbonate-36 mmol/lGlucose g/l *Schiwa

7 Patients Patients32 Male/ Female18 / 14 Age* [years] 5.3 (2 days - 19) Weight* [kg]14.1 ( ) BSA [m 2 ]0.63 ( ) *median (range)

8 Groups of Patients Septicemia 12 Liver failure9 Cardiac Disease5 Renal Disease3 Hyperammonemia3

9 Solutions for Substitution Schiwa SH39-Hep N24 Schiwa SH 198

10 Filters Used Diafilter 2020 Minifilter plus4 Minifilter /D205 Hemofilter 6S3

11 Blood and Dialysate Flow Blood flow [ml/kg/min]3.1 ( ) Exchange rate [ml/m 2 /h]475 ( ) Negative balance [ml/kg/h]4.2 (0 - 17)

12 CAVH Urea

13 Ultrafiltration

14 Number Filters Used

15 Filters clot 43/140 were lost this way (30.3%)

16 Duration of CVVH and Filter Survival Total duration of CVVH [h]56.5( ) Number of filters140 Survival of filter [h] 22.4( ) Reason for lossdeliberate change44 of a filterclotting43 operation/ CT scan16 end of CVVH27 technical problems5 plasmapheresis5

17 Technical Problems Switching between the 2 lines of the access4 Necessity to replace access2 3 Lumen oncologic catheter (Clearance 11)1

18 Renal Disease (3/3) Severe Hypertension during recurrent HUS1 Bilateral Nephrectomy during PD in an infant1 ATN after renal Tx1

19 Hyperammonemia (1/3) All 3 newborns received CVVHD DefectCNS involvementAmmonia [µmol/l] Citrullinemiamild encephalopathy Citrullinemia severe encephalopathy CPS def.cerebral edema

20 Heart Disease (1/5) TGA with Rastelli operation, bradyarrhythmias 2 Bradyarrhythmias1 Pulmonary atresia with interventional opening of the outflow tract1 Penetrating heart trauma with a bicycle1

21 Liver Disease (3/9) Liver transplantation (3 acute LF)7 Acute liver failure, no TX2 Complicating factors Re-transplantation2 Portal vein thrombosis2 CNS symptoms (seizure, edema)2 Severe rejection (plasmapheresis)1 Destruction of liver and spleen (horse kick)1

22 Septicemia(4/12) Bone MarrowTransplant2 Oncologic patient2 Heart/lungTx in CF, Liver Tx Waterhouse-Friedrichsen Sy., Schwachman Familial medit. Fever (amyloidosis)SCID Premature with NECSeptic RF 1 each

23 Causes of Death Multiple organ failure8 Circulatory failure4 Brain death3 Liver failure2 Rhabdomyolysis2 Complete bowel necrosis1

24 Major Complications Arterial hypotension15 / 32 Bleeding3 Thrombosis iliac vein1

25 Stenosis of Internal Jugular Vein Stenosis of the Internal Jugular Vein

26 CAVH Results

27 Intensive Care and Dialysis TotalDeath% Cases in intensive care LTx 15 (24), NTx 18 (31) ICU patients dialysed242.5 Dialysis24938 CVVH94 PD145 HD10

28 Conclusion CVVH broadens the array of treatment options in acute renal failure. It allows easier management through better fluid and solute clearances. However, this does not appreciably improve survival. Still, the original disease determines the prognosis - with renal failure being an negative predictor.

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