Skip to main content

Combined use of pumpless extracorporeal lung assist system and continuous renal replacement therapy with citrate anticoagulation in polytrauma patients

Introduction

The usefulness of a pumpless extracorporeal lung assist system (pECLA) and continuous renal replacement therapy (CRRT) in critically ill patients has been demonstrated in previous studies [1, 2]. The aim of this report was to examine combined use of pECLA and CRRT to improve carbon dioxide and inflammatory mediator removal, which allows for lung protective ventilation strategies.

Methods

In our 10 patients with ARDS due to polytrauma and sepsis, pECLA was established by insertion of cannulae to the femoral artery and vein. CRRT cannulae were introduced by venous line of the same vascular access (Figure 1). We preferred regional anticoagulation with trisodium citrate for both CRRT and ILA.

Figure 1
figure1

ILA and CRRT connected to the patient.

Results

Mean SAPS II and APACHE II scores were 55 and 23 respectively. Mean time on mechanical ventilation was 22 days. Mean ICU stay was 30 days for survivors and 38 days for nonsurvivors. When compared with baseline values most relevant parameters were the improvement in tidal volumes, plateau pressures, PaCO2 levels and pH (Figure 2). Four patients survived while six patients died from sepsis-MOF.

Figure 2
figure2

Changes in tidal volume, plateau pressure, pH and PaCO 2 .

Conclusion

We concluded that pECLA can effectively address the impaired gas exchange in ARDS and CRRT is a safe procedure with potential therapeutic value for treating MOF. Citrate anticoagulation was well tolerated and filter life was appropriate. The use of the same vascular access for ILA and CRRT may minimize invasive procedures and related side effects.

References

  1. 1.

    Bein T, et al.: Int J Emerg Med. 2010, 3: 177-179. 10.1007/s12245-010-0192-x

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    Demetrios J, et al.: Kidney Int. 2005, 67: 2361-2367. 10.1111/j.1523-1755.2005.00342.x

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to HK Atalan.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Atalan, H., Dumantepe, M., Denizalti, T. et al. Combined use of pumpless extracorporeal lung assist system and continuous renal replacement therapy with citrate anticoagulation in polytrauma patients. Crit Care 17, P64 (2013). https://doi.org/10.1186/cc12002

Download citation

Keywords

  • Continuous Renal Replacement Therapy
  • Vascular Access
  • Trisodium
  • Plateau Pressure
  • Ventilation Strategy