Wolff, E.D.

Haemofiltration in newborns treated with extracorporeal membrane oxygenation: A case-comparison study (Article)

2009-04-03T00:00:00Z

Introduction: Extracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Favourable effects of haemofiltration during cardiopulmonary bypass instigated the use of this technique in infants on extracorporeal membrane oxygenation. The current study aimed at comparing clinical outcomes of newborns on extracorporeal membrane oxygenation with and without continuous haemofiltration. Methods: Demographic data of newborns treated with haemofiltration during extracorporeal membrane oxygenation were compared with those of patients treated without haemofiltration in a retrospective 1:3 case-comparison study. Primary outcome parameters were time on extracorporeal membrane oxygenation, time until extubation after decannulation, mortality and potential cost reduction. Secondary outcome parameters were total and mean fluid balance, urine output in mL/kg/day, dose of vasopressors, blood products and fluid bolus infusions, serum creatinin, urea and albumin levels. Results: Fifteen patients with haemofiltration (HF group) were compared with 46 patients without haemofiltration (control group). Time on extracorporeal membrane oxygenation was significantly shorter in the HF group: 98 hours (interquartile range (IQR) = 48 to 187 hours) versus 126 hours (IQR = 24 to 403 hours) in the control group (P = 0.02). Time from decannulation until extubation was shorter as well: 2.5 days (IQR = 0 to 6.4 days) versus 4.8 days (IQR = 0 to 121.5 days; P = 0.04). The calculated cost reduction was €5000 per extracorporeal membrane oxygenation run. There were no significant differences in mortality. Patients in the HF group needed fewer blood transfusions: 0.9 mL/kg/day (IQR = 0.2 to 2.7 mL/kg/day) versus 1.8 mL/kg/day (IQR = 0.8 to 2.9 mL/kg/day) in the control group (P< 0.001). Consequently the number of blood units used was significantly lower in the HF group (P< 0.001). There was no significant difference in inotropic support or other fluid resuscitation. Conclusions: Adding continuous haemofiltration to the extracorporeal membrane oxygenation circuit in newborns improves outcome by significantly reducing time on extracorporeal membrane oxygenation and on mechanical ventilation, because of better fluid management and a possible reduction of capillary leakage syndrome. Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower.

Point-of-care creatinine testing in children at risk for sudden deterioration of renal function (Article)

2007-11-11T00:00:00Z

Background: Point-of-care testing for creatinine blood concentrations may be useful in predicting the onset of recurrent conditions threatening renal function in children at home. Our aim was to evaluate two point-of-care systems for creatinine testing vs. an automated creatinine assay. Methods: Twenty patients aged between 2 months and 17 years were randomly selected. Capillary blood specimens were taken for two point-of-care tests (Reflotron and i-STAT), and the results were compared to the routine enzymatic creatinine assay on a Hitachi 912 analyser using material collected simultaneously. Results: The mean difference in creatinine concentration between the Reflotron and the Hitachi 912 and i-STAT and Hitachi 912 test was -16 and 4 μmol/L, respectively. The slope of the Passing-Bablok method comparison was 0.95 (95% CI 0.87-1.06) and 0.96 (95% CI 0.90-1.00) for the Reflotron and i-STAT test, respectively. Conclusions: The blood creatinine concentrations measured using the Reflotron and the i-STAT device correlated well with those from the routine assay, especially in the concentration range up to 500 μmol/L. Both systems are good options for point-of-care creatinine testing in capillary blood. However, the i-STAT seems the better option for monitoring at home given its greater ease of use.

Liver transplantation in the rat (Doctoral Thesis)

1976-06-09T00:00:00Z

During the past ten years progress in the field of vascular surgery and immunology has been such, that a steady improvement in the results of clinical organ transplantation can be observed. Also when a life threatening disease of the liver is present, liver transplantation may be considered. In general these diseases may be described as follows: Necrosis of the liver, acute or sub-acute, can give rise to a progressive loss of the liver function. The causal factors are very often unknown. Sometimes certain hepatotoxins can be indicated as the cause. Halothane, for instance, may give rise to acute hepatic necrosis of the liver (Silverman 1975). Viral hepatitis can also produce such serious damage to the liver, that it endangers life.