Chairs: U. Julius (Dresden, Germany), P. M. Moriarty (Kansas City, USA)
Invited experts for discussion: W. Druml, L. Kramer, Ch. Madl, P. Schenk (Vienna, Austria)
|Recent advances in critical care apheresis in Japan
1 Shiga University of Medical Science, Department of Clinical Nursing, Otsu, Japan
2 Shiga University of Medical Science, Department of Surgery, Otsu, Japan
3 Shiga University of Medical Science, Biomedical Innovation Center, Otsu, Japan
Abstract text :
In Japan, acute liver failure and sepsis are major indications for apheresis in critical care. PE, DFPP, direct hemo-/plasma adsorption and CH(D)F have been used as the method of plasmapheresis. As other new techniques, such as selective plasma exchange, plasma filtration with dialysis, modified DFPP, DF thermos and CART, are developed and used in the clinical situation.
Plasma filtration with dialysis (PDF) was developed by Prof. Eguchi and recently covered by Japanese health insurance system. Some arranged methods of PDF were reported. Prof. Nakae reported selective plasma exchange with dialysis (PED). PED is the apheresis in which simple plasma exchange is performed with a selective membrane plasma separator (Evavure EC-4A), while letting the dialysate flow outside of the hollow fibers. The removal rates of the substance in PED using EC-4A was higher compared with those in plasma filtration with dialysis (PDF) using EC-2A, while maintaining the serum albumin concentration. Prof. Taniguchi also reported a new method which was known as continuous PDF (CPDF) therapy could be administered to unstable patients with acute liver failure.
Concerning the treatment of sepsis, PMX has been approved for therapeutic use in Japan and Europe, and it has been used safely and effectively on more than 150,000 patients to date. The only double blinded, randomized trial of PMX (The EUPHRATES Trial) demonstrated that PMX therapy increased both ventilator free and renal replacement therapy free days. Additionally, patients who received PMX therapy had a greater increase in mean arterial pressure as well as a decreased requirement for vasopressors. And the effectiveness was most evident in in the subgroup of patients with abdominal infection with shock, an MOD score of more than 9 and an EAA of between 0.6 and 0.9. Other systemic reviews were reported the significant results which PMX was effective especially for severe cases.
|Extracorporeal therapies in liver failure
1 Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Germany
Abstract text :
Liver failure is a frequent kind of organ failure at the intensive care unit (ICU) affecting up to 20 percent of the critically ill patients. Usually, several types of liver failure can be distinguished: cholestasis, hypoxic liver injury, acute on chronic liver failure and acute liver failure. Patients with liver failure have dramatically increased morbidity and mortality rates of up to 80 percent depending of the kind of liver failure and the severity of disease. Apart from prophylactic measures, therapeutic options include treatment of the underlying disease that triggered liver failure, bundles of care that are routinely applied in critically ill patients at the ICU and extracoporeal therapies. Apart from conventional renal replacement therapies, albumin dialysis devices and plasma exchange are available for extracorporeal treatment of liver failure and multi organ failure. Although renal replacement therapies are the most common used extracorporeal devices in patients with liver failure, there is no data available, assessing its safety, efficacy and effectiveness in this population in randomized controlled trials. In contrast, randomized controlled trials are available using albumin dialysis and plasma exchange in this setting. Use of plasma exchange was associated with significantly decreased mortality rates in patients with acute liver failure. Albumin dialysis was safe and reduced important clinical end points like hepatic encephalopathy, hemodynamics and jaundice. However, improvement of survival was observed only in subgroups in the largest randomized controlled studies. This talk of Dr. Fuhrmann will summarize the current available data of extracorporeal therapies in liver failure and will give an outlook on emerging therapeutic options of extracorporeal therapies in the field of liver failure.