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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1998 March;64(3):83-7

Copyright © 1998 EDIZIONI MINERVA MEDICA

language: English

CVVH in postoperative care of liver transplantation

Fiore G., Donadio P. P., Gianferrari P., Santacroce C., Guermani A.

Azienda Ospedaliera San Giovanni Battista, Sede Molinette - Torino, III Anestesia e Rianimazione Ospedaliera


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Objec­tive. To eval­uate ­CVVH (Con­tin­uous ­Veno-­Venous Hemo­fil­tra­tion) as ­acute ­renal replace­ment treat­ment in post­op­er­a­tive ­care of ­liver trans­plan­ta­tion.
­Design. Ret­ro­spec­tive ­study.
Set­ting. Inten­sive ­Care ­Unit, ­year 1995.
­Patients. 86 OLT per­formed in 1995, 11 of ­them under­went ­acute ­renal replace­ment treat­ment. In the ­same ­period, in the ICU ­were ­admitted 237 ­patients, and 20 under­went ­acute ­renal replace­ment treat­ment (con­trol ­group).
Eval­u­a­tion ­with ­SOFA (­Sepsis-­related ­Organ ­Failure Assess­ment) ­score.
Inter­ven­tion. ­CVVH per­formed hep­arin ­free, ­pump ­system, poly­amide or poly­sul­phone 0.6 mq mem­brane hemo­filter ­device, ­blood ­flow 150-200 ml/min, UF ­rate 1000-1200 ml/h, clear­ance 16-20 ml/min.
Meas­ure­ments. Coag­u­la­tion mon­i­toring (PT as INR, PTT, ­fibrinogen, anti­thrombin III, d-­dimer, ­platelet ­count) was per­formed 3 ­times a day or on vari­a­tion of the clin­ical con­di­tions.
­Results. ­SOFA ­score did not ­differ ­between the two ­groups. Mor­tality was ­higher in the ­patients ­treated ­with ­CVVH. ­CVVH was per­formed ­from 16 to 18 hrs/day for 9.90±2.33 ­days. ­Three ­patients devel­oped clin­ical ­bleeding ­before ­CVVH, 3 ­during ­CVVH but 1 of ­them under­went ­repeated sur­gical pro­ce­dures.
Con­clu­sions. We ­cannot dem­on­strate ­that ­CVVH ­doesn’t ­affect ­bleeding, but we can say ­that, for the com­plexity of the ­post OLT ­patients, ­CVVH can be the treat­ment of ­choice in ­case of ­renal replace­ment treat­ment.

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