List the extracoporeal therapies used in the critically ill and outline the indications for their use.
College Answer
1) Dialytic techniques.
Traditional indications used for acute renal failure, are concerns about fluid overload (actual or to facilitate nutritional support), hyperkalaemia or other uncontrolled electrolyte disorders, metabolic acidosis, hyponatraemia, uraemic symptoms or elevated urea (e.g. 30 mmoJIL).
2) Dialysis or haemoftltration (e.g. with charcoal filter) can be used to increase the clearance of toxic products from the circulation (e.g. lithium, theophylline, myoglobin).
3) Newer related extracorporeal techniques have also been developed to support liver dysfunction.
4) ECMO - Severe respiratory failure
5) ECC02-Severe respiratory failure
6) Extracorporeal ventricular assist device - Severe myocardial dysfunction
7) Plasmapheresis/filtration-meningococal infection, Guilian Barre, ITP
Discussion
This question would benefit from a tabulated answer.
Therapy | Indications |
Dialysis |
|
Hemoperfusion |
|
ECMO |
|
ECCO2R |
|
MARS |
|
Plasma exchange |
|
LVAD/RVAD |
|
References
Hughes, T., et al. "Novel uses of arteriovenous extracorporeal membrane carbon dioxide removal (AV-ECCO2R)–two case studies." (2013): 169-73.