Abstract | OBJECTIVE: DESIGN AND SETTING: Prospective cohort trial in medicosurgical intensive care units of two university-affiliated teaching institutions. PATIENTS: INTERVENTION: A convection-based citrate anticoagulation CVVHDF regimen using an isotonic replacement fluid containing citrate administered in predilution. A neutralizing solution of calcium chloride and magnesium sulfate was infused at the end of the circuit. Blood flow rate was set and kept at 125 ml/min, and the flow rate of the replacement fluid was initiated at 1250 ml/h and adjusted thereafter according to the monitoring of blood activated coagulation time (ACT), with a target between 180 to 220 s. MEASUREMENTS AND RESULTS: The average filter time-life was 44 h. Thrombosis of the proximal portion of the circuit (which was not anticoagulated) was the main reason for technique failure. A mean urea clearance of 21 ml/min was obtained. Electrolytes and acid-base balance were both well maintained. Six percent (16/287) of Ca(i) readings less than 0.3 mmol/l were associated with very high ACT levels (>300 s). CONCLUSIONS: This regimen is shown to be safe, efficacious, and convenient. Citrate anticoagulation should be monitored using postfilter ACT and/or ionized calcium with respective targets of 200-250 s or 0.3-0.4 mmol/l.
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Authors | Marc Dorval, François Madore, Sylvie Courteau, Martine Leblanc |
Journal | Intensive care medicine
(Intensive Care Med)
Vol. 29
Issue 7
Pg. 1186-9
(Jul 2003)
ISSN: 0342-4642 [Print] United States |
PMID | 12761615
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Anticoagulants
(therapeutic use)
- Citrates
(therapeutic use)
- Hemofiltration
(methods)
- Humans
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