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Yaroustovsky et al. Blood purification in intensive care patients

dictated by an inadequate PD dosing in metabolic indications. Its elimination of medium-molecular
and water-electrolyte disorders with severe edema depressive factors, which are elevated in MODS
syndrome, tissue hyperhydration and the preservation and sepsis, [2,8] and correction of hyperkalemia and
of azotemia. Carrying out constant HF/HD in azotemia prevent the development of immune paralysis
infants makes it possible to achieve the necessary and uremic polyserositis. During extracorporeal
fluid balance, and decreases in CVP and Pla are procedures, it is possible to normalize body temperature
accompanied by MAP and LVEF increases, which and temperature balance as a whole.
allow inotropic support reduction in some cases. [13]
The ability to perform the necessary volume of
We are in strong agreement with researchers who infusion-transfusion therapy in anuria and tissue
believe that hemodynamic and gas exchange hyperhydration without the risk of hypervolemia is
improvements are associated with the optimization of very important.
circulating blood volume and plasma colloid osmotic
pressure. We also think that blood purification’s Because of the high risk of both hypo- and
[5]
positive effects are implemented by filtration of hypercoagulation in cardiosurgery patients, choosing
interstitial fluid excess and reduction of myocardial and the anticoagulation mode carefully is also very
pulmonary edema. [8] important.

The effectiveness of any blood purification method CVVHF IN CONJUNCTION WITH ECMO
in cardiosurgery patients depends on the adequate
correction of electrolyte (hyperkalemia, hyper- and/or IN CHILDREN WITH CRITICAL HEART
hyponatremia) and metabolic (lactatemia, acidosis, FAILURE AND ACUTE KIDNEY INJURY
alkalosis) disorders and azotemia. Hyperkalemia AFTER CARDIAC SURGERY
is caused by acute kidney injury, catabolism,
rhabdomyolysis and reperfusion after crash syndrome, Due to the significant expansion of cardiac
hemolysis and disseminated intravascular coagulation. surgery worldwide, the number of ECMO patients
It is often aggravated by concomitant metabolic in the near postoperative period has increased
acidosis and is an additional cardiotoxic factor. significantly. Severe cardiac and/or respiratory
failure is accompanied by cardiogenic shock
The diffusion and filtration rates during continuous and hypoxia with MODS and AKI development.
veno-venous hemofiltration (CVVHF) or CVVHF These patients have hypervolemia and electrolyte
dialysis permit one to correct azotemia, hyperkalemia disorders (hyperkalemia, hypocalcemia, hypo- or
and metabolic parameters and control them later. In hypernatremia, tissue hyperhydration), which can
[14]
contrast to PD, constant or intermittent extracorporeal increase azotemia and metabolic disorders. Thus,
therapy stabilizes and significantly reduces the continuous hemofiltration in conjunction with ECMO
azotemia level earlier, quickly corrects hyperkalemia is a justified method of correcting the entire complex
and metabolic disorders, and provides clearance of of homeostatic disorders. [15]
exo- and endotoxins.
Many medical centers offer continuous RRT as
Extracorporeal blood purification in adult and pediatric the most manageable and effective method. We
[16]
MODS patients is used for both renal and extrarenal chose CVVHF, which influences various aspects of
the pathogenesis of MODS, inhibits its development
and progression, and helps eliminate the medium
molecular weight substances, thereby contributing
to a decrease in inflammatory cascade activity. In
[17]
addition, the use of high volumes of replacement
liquids (more than 30-35 mL/kg/h) can be of great
importance for enhancing lymphatic transport between
the intercellular space, tissues and blood and for
reducing the activity of the inflammatory cascade.

The results of the treatment and its cost allow the
conclusion that CVVHF connected to an ECMO circuit
Figure 1: Hemodynamics parameters during peritoneal dialysis.
CVP: central venous pressure; Pla: left atrial pressure; MAP: mean (single circuit) is relatively simple and has advantages
arterial pressure; LVEF: left ventricle ejection fraction for intensive care patients. [18,19]
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