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  • 1
    Electronic Resource
    Electronic Resource
    Continuous venovenous haemofiltration using polyacrylonitrile filters does not activate contact system and intrinsic coagulation pathways (1997)
    Springer
    Intensive care medicine 23 (1997), S. 38-43 
    Details
    ISSN: 1432-1238
    Keywords: Key words Haemofiltration ; Polyacrylonitrile ; Intensive care ; Contact system ; Intrinsic coagulation pathway
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To investigate whether continuous venovenous haemofiltration using polyacrylonitrile filters causes activation of the contact system and intrinsic coagulation pathways and if this, and/or low plasma levels of endogenous anticoagulants, influences filter lifespan. Design: Observational study. Setting: University Teaching Hospital Intensive Care Unit. Patients: Twelve critically ill patients with acute renal failure receiving continuous venovenous haemofiltration. Interventions: Blood samples were taken before starting haemofiltration, at 15 min, 1 h, 3–4 h, 8–12 h, 24 h and at 24-h intervals thereafter until filter blockage occurred. Measurement was made of the contact and intrinsic coagulation system proteins factor XII, activated factor XII and prekallikrein and the protease inhibitors antithrombin III, heparin co-factor II, alpha2-macroglobulin and C1-esterase inhibitor. Thrombin-antithrombin complex levels were measured to provide evidence of thrombin generation. Results: (i) Factor XII, prekallikrein and contact system inhibitors were subnormal in 10/12 and activated factor XII raised in 11/12 patients at baseline, implying pre-existing contact pathway activation. (ii) No change occurred during haemofiltration in the intrinsic coagulation pathway factor or inhibitor levels. (iii) Clotting of the filter circuit within the first 24 h occurred in 5/12 and was associated with low baseline levels of antithrombin III and heparin co-factor II. Only in these patients did thrombin-antithrombin complex levels rise significantly. Conclusions: The contact system was not activated further by continuous venovenous haemofiltration using polyacrylonitrile filters in critically ill patients. Premature clotting of the haemofilter circuit was more common in patients with very low levels of antithrombin III and heparin co-factor II; although this was related to thrombin generation, the intrinsic coagulation pathway does not appear to be implicated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050288
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Endothelial dysfunction in critically ill patients: the effect of haemofiltration (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1264-1271 
    Details
    ISSN: 1432-1238
    Keywords: Key words Haemofiltration ; Endothelial injury ; Coagulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To examine the effect of a single episode of continuous venovenous haemofiltration (CVVH) on indicators of endothelial injury and the protein C/S system in critically ill patients. Design: Observational study. Setting: University teaching hospital intensive care unit. Patients: 12 critically ill patients with acute renal failure receiving their first episode of CVVH. Interventions: Blood samples were collected prior to starting CVVH and at 15 min and 1, 3–4, 8–12, and 24 h, and at 24-h intervals thereafter until the filter clotted. Measurements and results: Soluble tissue factor, soluble thrombomodulin, E-selectin and endothelin-1 were measured as indicators of endothelial injury. Changes in the protein C/S system were assessed by measurement of protein C (PC) and both free and total protein S (PS). Levels of PC and both free and total PS were subnormal in 6 and 11 patients, respectively, prior to CVVH, but there were no further changes during CVVH. Levels of tissue factor, thrombomodulin, E-selectin, and endothelin-1 were raised prior to haemofiltration in 9, 10, 9 and 9 patients, respectively. There were further increases during CVVH in at least one, but not all, of the markers of endothelial injury in most patients. There was no consistency between the changes in different markers of endothelial injury during haemofiltration in individual patients. Conclusions: The PC/PS system and endothelial integrity is compromised in critically ill patients prior to haemofiltration, but a single episode of CVVH has little effect on the PC/PS system. The increase in markers of endothelial dysfunction seen during CVVH is more likely to be related to the underlying condition of the patient rather than any specific consequence arising from the technique itself.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050760
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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