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Renal Intensive Care

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.

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Renal Intensive Care

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  1. Renal Intensive Care

  2. Sepsis – The “real milieu” Rivers, E. P. et al. CMAJ 2005;173:1054-1065 Sepsis

  3. 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 Severe sepsisComparison with other major diseases & Economic Aspect †National Center for Health Statistics, 2001.§American Cancer Society, 2001. *American Heart Association. 2000.‡Angus DC et al. Crit Care Med. 2001 Sepsis

  4. 1,800,000 Severe Sepsis Cases 1,600,000 US Population 1,400,000 1,200,000 1,000,000 Sepsis Cases 800,000 600,000 400,000 200,000 2001 2025 2050 Severe Sepsis An increasing problem Year *Angus DC. Crit Care Med. 2001 Sepsis

  5. Common Sources of Infection • 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 Sepsis

  6. Sepsis: A Complex Disease Adapted from: Bone RC et al. Chest. 1992;101:1644-55. Opal SM et al. Crit Care Med. 2000;28:S81-2. MODS The inflammatory changes of sepsis are tightly linked to disturbed hemostasis. Sepsis

  7. “mixed” “pro” “anti” SIRS = Systemic inflammatory response syndrome Infection Sepsis Death Severe Sepsis MODS Hyper-inflammation Normal CARS = Compensatory anti-inflammatoryresponse syndrome Immunoparalysis We don’t always know where we are on the spectrum Sepsis

  8. Extracorporeal therapies for acute renal failure Sepsis

  9. How to treat sepsis • Pharmacologic • Antibiotics • Vasopressors • Steroids • Xigris • 2. Extracorporeal therapy • Generally accepted for Sepsis+ARF • No evidence, (not accepted) for Sepsis alone • CRRT therapies Sepsis

  10. anti endotoxin (polymyxin or moAb) anti TNF antibodies TNF soluble receptors IL-1 receptor antagonists Bradykinin agonists PAF receptor antagonists Treatment Strategies bacteria early mediator late mediator late mediator Sepsis

  11. Brain Heart (hemodynamics) Lungs Kidneys Liver Blood and coagulation Sepsis chain and therapeutic approch Multi-Organ Dysfunction Systemic Inflammatory Response Infection Reduce systemic reaction Eliminate infection Support organs antibiotics • Steroids • Insulin (glucose control) • Antiinflammatory agents • Ventilation • IV fluids • Vasopressors Toraymixina xigris CRRT Sepsis

  12. Adsorption (Specific or not specific) • External “interphase” • Transfer solute from bulk • Thin film on outer surface of resin • Internal “intraphase” • Solute enters pore by diffusion • Surface Diffusion • Surface Adsorption • hydrophobic binding • Affinity binding (if specific resin) Adapted Winchester ASN 2002 Sepsis

  13. CPFA anticoagulant Sepsis

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