Renal Intensive Care

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Renal Intensive Care

description

Renal Intensive Care. Sepsis – The “ real milieu ”. Rivers, E. P. et al. CMAJ 2005;173:1054-1065. Sepsis. Cost of care for traditional (Farmacologic) treatment of septic patient €26.373 Sepsis costs Today €17.4 billion in USA €7.6 billion in Europe. - PowerPoint PPT Presentation

Transcript of Renal Intensive Care

Page 1: Renal Intensive Care

Renal Intensive Care

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Rivers, E. P. et al. CMAJ 2005;173:1054-1065

Sepsis – The “real milieu”

Sepsis

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Severe sepsis Comparison with other major diseases &

Economic Aspect

Cost of care for traditional (Farmacologic)

treatment of septic patient €26.373

Sepsis costs Today

€17.4 billion in USA

€7.6 billion in Europe

†National Center for Health Statistics, 2001. §American Cancer Society, 2001. *American Heart Association.

2000. ‡Angus DC et al. Crit Care Med. 2001

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AIDS BreastCancer

AMI SevereSepsis

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100

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SevereSepsis

Sepsis

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*Angus DC. Crit Care Med. 2001

Severe Sepsis An increasing problem

Year

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2001 2025 2050

Severe Sepsis Cases

US Population

Sep

sis

Cas

es

Sepsis

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• The Lungs– Hospital acquired infection– Pneumonia

• The Abdomen– Appendicitis– bowel problems– gallbladder – peritonitis

• The Urinary Tract– Urinary catheter– Diabetic patients UTI

• The Skin– Wounds– Skin inflammation– Catheter infection

Common Sources of Infection

Sepsis

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Sepsis: A Complex Disease

The inflammatory changes of sepsis are tightly linked to disturbed hemostasis.

Adapted from: Bone RC et al. Chest. 1992;101:1644-55.

Opal SM et al. Crit Care Med. 2000;28:S81-2.

MODS

Sepsis

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We don’t always know where we are on the spectrum

Infection Sepsis Severe Sepsis MODS Death

SIRS = Systemic inflammatory response syndrome

CARS = Compensatory anti-inflammatoryresponse syndrome

Hyper-inflammation

Normal

Immunoparalysis

“pro”“mixed”

“anti”

Sepsis

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Extracorporeal therapies for acute renal failure

0 20 40 60 80

ARF +sepsis

ARF -sepsis

Sepsis

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How to treat sepsis1.Pharmacologic

• Antibiotics• Vasopressors• Steroids• Xigris

2. Extracorporeal therapy

• Generally accepted for Sepsis+ARF• No evidence, (not accepted) for Sepsis alone• CRRT therapies

Sepsis

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bacteria

earlymediator

latemediator

latemediator

anti endotoxin (polymyxin or moAb)

anti TNF antibodiesTNF soluble receptorsIL-1 receptor antagonistsBradykinin agonistsPAF receptor antagonists

Treatment Strategies

Sepsis

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Infection

Systemic Inflammatory

Response

Multi-Organ Dysfunction

Eliminate infection Reduce systemic reaction

Support organs

IV fluidsVasopressors

xigris

Sepsis chain and therapeutic approch

Heart (hemodynamics)

Liver

Lungs

Kidneys

Blood and coagulation

Brain

antibiotics Steroids

Insulin (glucose control)

Antiinflammatory agents

Ventilation

CRRT

Toraymixina

Sepsis

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1. External “interphase”Transfer solute from bulkThin film on outer surface of resin

2. Internal “intraphase”Solute enters pore by diffusion

3. Surface Diffusion

4. Surface Adsorptionhydrophobic bindingAffinity binding (if specific resin)

Adapted Winchester ASN 2002

Adsorption (Specific or not specific)

Sepsis

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anticoagulant

CPFA

Sepsis

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