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Master Thesis

Effectiveness and safety of regional citrate anticoagulation for membrane-based therapeutic plasma exchange in the intensive care

Abstract : Objective: To evaluate the effectiveness and safety of regional citrate anticoagulation (RCA) in membrane-based plasma exchange (mTPE) therapy for ICU patients. Design: Retrospective observational study. Setting: 18-bedded adult intensive care unit. Patients: Retrospective cohort of all patients receiving mTPE between April 2013 and July 2016. Interventions: None. Measurement and Main Results: The primary endpoint was the occurrence of circuit clotting. Secondary endpoints were the safety of plasma exchange, and tolerance of RCA. Two hundred and sixty mTPE sessions performed in 24 patients were included. Mean SAPS 2 score was 32 ± 17. Thrombotic microangiopathy (n = 12, 50%) was the commonest indication for mTPE. During each session, 1.5x the total estimated plasma volume was exchanged. A fixed rate protocol was employed for the first session of each patient. A total of 29 treatments (11.2%, 95% CI 7.3 - 14.8) performed in 10 patients were complicated by circuit clotting. Clotting risk was not related to patient characteristics. A larger substitution volume (4079 ml vs 3882 ml, p = 0.01) and more frequent changes in calcium substitution (24% vs 6.5%, p = 0.004) were observed during the sessions where thrombosis occurred within the circuit. Adverse clinical events (but no major complications) were noted in 7 patients (29 %) during 11 sessions (4.2 %). Metabolic parameters were not significantly altered by RCA. Mean plasma ionized calcium (iCa) decreased during RCA by 0.11 ± 0.12 mmol/l. . Conclusion: Regional citrate anticoagulation appears to be an effective and safe choice for membrane based therapeutic plasma exchange in the intensive care setting.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03087225
Contributor : Jean-Hugues Morneau <>
Submitted on : Wednesday, December 23, 2020 - 3:30:30 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:24 AM

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  • HAL Id : dumas-03087225, version 1

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Simon Klein. Effectiveness and safety of regional citrate anticoagulation for membrane-based therapeutic plasma exchange in the intensive care. Human health and pathology. 2018. ⟨dumas-03087225⟩

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