regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding a continuous veno-venous hemofiltration protocol with a low concentration citrate solution地区枸橼酸抗凝心脏手术出血的高危患者静脉对静脉持续性血液滤过协议与柠檬酸低浓度的解决方案.pdfVIP

Morabito et al. Critical Care 2012, 16:R111 /content/16/3/R111 RESEARCH Open Access Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution 1* 1 2 1 1 1 Santo Morabito , Valentina Pistolesi , Luigi Tritapepe , Laura Zeppilli , Francesca Polistena , Emanuela Strampelli and Alessandro Pierucci1 Abstract Introduction: Regional citrate anticoagulation (RCA) is a valid option in patients at high risk of bleeding who are undergoing continuous renal replacement therapy (CRRT). The aim of this study was to evaluate, in critically ill patients with severe acute kidney injury following cardiac surgery, the efficacy and safety of RCA-continuous veno- venous hemofiltration (CVVH) using a low concentration citrate solution. Methods: In high bleeding-risk cardiac surgery patients, we adopted, as an alternative to heparin or no anticoagulation, RCA-CVVH using a 12 mmol/l citrate solution. For RCA-CVVH settings, we developed a mathematical model to roughly estimate citrate load and calcium loss. In order to minimize calcium chloride supplementation, a calcium-containing solution was used as post-dilution replacement fluid. Statistical analysis was performed using the Student t-test or analysis of variance (ANOVA) with post-hoc tests, Wilcoxon or Kruskal-Wallis tests for non-parametric analysis, and Kaplan-Meier survival analysis with Log Rank test. Results: Thirty-three patients (age 70.8 ± 9.5, Sequential Organ Failure Assessment (SOFA) score 13.9 ± 2.5) were switched to RCA-CVVH from no anticoagulation CRRT. Among them, 16 patients had been previously switched from hepa