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Plasma exchange as ...
Plasma exchange as rescue therapy in multiple organ failure including acute renal failure
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- Stegmayr, B. G. (författare)
- Umeå universitet,Medicin
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Banga, R. (författare)
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Berggren, L. (författare)
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Norda, R. (författare)
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- Rydvall, A. (författare)
- Umeå universitet,Anestesiologi och intensivvård
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Vikerfors, T. (författare)
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(creator_code:org_t)
- 2003
- 2003
- Engelska.
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Ingår i: Crit Care Med. ; 31:6, s. 1730-6
- Relaterad länk:
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http://www.ncbi.nlm....
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- OBJECTIVE: To describe the outcome of using a rescue therapy including plasma exchange given to patients with a progressive acute disseminated intravascular coagulation and multiple organ dysfunction syndrome. STUDY DESIGN: Retrospective study. SETTING: University and county hospital. PATIENTS: Included were 76 consecutive patients (41 men and 35 women) treated with plasma exchange as rescue therapy besides optimal conventional therapy during a progressive course of disseminated intravascular coagulation and multiple organ dysfunction syndrome, including acute renal failure. Of the 76 patients, 66% needed dialysis. The distribution was hemodialysis in 76%, continuous arteriovenous hemofiltration in 36%, continuous venovenous hemodialysis in 12%, and peritoneal dialysis in 24%. The median organ-failure score was 5 (range, 1-6). Seventy-two percent required mechanical ventilation; septic shock was present in 88%. The median septic shock score was 4 (range, 2-4). Nine patients had another reason than sepsis for the multiple organ dysfunction syndrome. INTERVENTION: Plasma exchange (centrifugation technique) was performed until disseminated intravascular coagulation was reversed (median, two times; range, 1-14). Besides antibiotics and fluid administration, most patients received heparin or low molecular weight heparin (77%), steroids (87%), and inotropes (88%). More than one vasoactive drug was used in 57% of the patients. MEASUREMENTS AND MAIN RESULTS: Eighty-two percent of the patients survived and could leave the hospital. The previously observed survival rates by others for this category of patients would be <20%, and thus, the outcome in this study is significantly better. CONCLUSION: Plasma exchange using plasma as replacement may, in addition to conventional intensive care, help to reverse severe progressive disseminated intravascular coagulation and multiple organ dysfunction syndrome and improve survival.
Nyckelord
- Adolescent
- Adult
- Aged
- Aged
- 80 and over
- Child
- Preschool
- Combined Modality Therapy
- Disseminated Intravascular Coagulation/mortality/*therapy
- Female
- Humans
- Kidney Failure
- Acute/*therapy
- Male
- Middle Aged
- Multiple Organ Failure/etiology/mortality/*therapy
- *Plasma Exchange/adverse effects
- Renal Dialysis
- Retrospective Studies
- Sepsis/complications/microbiology
- Survival Rate
- Sweden/epidemiology
- Treatment Outcome
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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