Abstract
The present study was undertaken to investigate the efficacy of various blood purifications in emergency and critical care medicine. During past 6 years, we applied hemodialysis (HD), continuous hemofiltration (CHF), continuous hemodiafiltration (CHDF), peritoneal dialysis (PD), plasma exchange (PE), double filtration plasmapheresis (DFPP), hemoadsorption (HA), plasma adsorption (PA) and endotoxin adsorption with polymyxin B immobilized fiber (PMX) on 160 patients in our institution resulting in the survival rate of 60%. Among these various blood purifications, CHF and CHDF could be applied safely even on patients with unstable hemodynamic condition. For anuric critically ill patients, CHF and CHDF were particularly effective to maintain water, electrolytes and acid-base balance, to remove metabolic products and to make nutritional management easier. Another possible effect of CHF and CHDF was the removal of humoral media-tors or causative substances of multiple organ failure (MOF). We applied PE, PA and CHDF on patients with hepatic failure, and DFPP on patients with autoimmune disease. Under the proper use of anticoagulant such as low molecular weight heparin or nafamostat mesilate, CHF and CHDF could be performed safely without remarkable bleeding complication. From these results, we conclude that blood purification is effective and safe modality in the emergency and critical care medicine, and that it becomes an inevitable therapeutic tool in this field.
Keywords emergency and critical care medicine, blood purification, continuous hemofiltration (CHF), continuous hemodiafiltration (CHDF)