2017 Volume 8 Issue 1 Pages 48-53
Continuous hemofiltration (AN-CHF) using an AN69ST hemofilter often causes blood coagulation in the venous chamber. We have postulated that this is due to the adsorption of nafamostat mesilate (NM), although this remains to be investigated. In our ICU, only prefilter NM administration was previously employed, but, subsequently, pre- and post-filter NM administration were introduced. Sepsis patients who received AN-CHF were selected and compared retrospectively regarding the administration methods (Method A: prefilter administration of NM at 30mg/hr; Method AV：prefilter at 25mg/hr and postfilter at 5mg/hr). Considering time loss due to CHF exchange and the inconvenience of exchange off duty, we defined cases where AN-CHF was performed for more than 22 hours with a single filter as “target achievement.” As a result, no significant difference was noted in lifetimes (23.5 hours for Method A vs. 23.2 hours for Method AV, p＝0.60) or target achievement rates (85.1% for Method A vs. 78.9% for Method AV, p＝0.34). Sequential organ failure assessment scores (odds ratio: 0.997, p=0.0002) and Method AV (odds ratio: 0.216, p=0.011) were included as factors contributing to target achievement. In conclusion, the divided administration of NM prefilter at 25mg/hr and postfilter at 5mg/hr was not effective for circuit lifetime in this study.
