Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Technical Aspects of Pediatric Continuous Renal Replacement Therapy

Objectives This chapter will: 1. Outline the basic principles of continuous renal replacement therapy as they apply in pediatric patients. 2. Delineate the particular aspects of pediatric continuous renal replacement therapy that differ from adult continuous renal replacement therapy in terms of prescription, thermic control, access, and anticoagulation. 3. Review the concept of the blood priming–bradykinin-release phenomenon and its importance in infant continuous renal replacement therapy…

Treatment of Acute Kidney Injury in Children: Conservative Management to Renal Replacement Therapy

Objectives This chapter will: 1. Review the cause of pediatric acute kidney injury, correlated with reversibility and outcome. 2. Outline the components of conservative management of pediatric acute kidney injury. 3. Present an approach to dialytic management of pediatric acute kidney injury. Management of acute kidney injury (AKI) in a child should begin with a thorough etiologic evaluation to pinpoint the underlying cause or causes and…

Epidemiology of Pediatric Acute Kidney Injury

Objectives This chapter will: 1. Review the major causes of acute kidney injury in critically ill pediatric patients. 2. Describe pediatric acute kidney injury seen in different subpopulations, including infants in the postoperative period after corrective congenital heart surgery, stem cell transplant recipients, and patients with multiple organ dysfunction syndrome. 3. Review new diagnostic measures for pediatric acute kidney injury with a focus on classification systems.…

Cellular and Molecular Mechanisms of Acute Kidney Injury

Objectives This chapter will: 1. Describe cellular and molecular mechanisms at the base of acute kidney injury pathophysiology. 2. Detail alterations occurring at genetic, histologic, tubular, glomerular, and vascular levels. 3. Describe the role of nephrotoxins, inflammation, and organ cross-talk during critical illness. Acute kidney injury (AKI) is a common clinical problem with increasing incidence, serious consequences, and unsatisfactory therapeutic options in children and adults. AKI…

Cell-Based Therapies

Objectives This chapter will: 1. Present the scientific rationale for renal stem cell and progenitor cell therapy. 2. Describe an extracorporeal approach to renal cell replacement therapy. 3. Present the scientific basis of continuous cell processing in an extracorporeal device. 4. Summarize preclinical and clinical data on these cell-based approaches. Acute and chronic solid organ failures are costly disease processes with high mortality rates. Inflammation plays…

Extracorporeal Membrane Oxygenation for Pulmonary Support

Objectives This chapter will: 1. Describe the main aspects of venovenous extracorporeal membrane oxygenation (ECMO) circuit and functionality. 2. Describe the indication to start and to stop ECMO for pulmonary support. 3. Detail the currently available literature. 4. Acknowledge limitations and complications of venovenous ECMO. Extracorporeal membrane oxygenation (ECMO) is a temporary artificial support used for respiratory and/or cardiac failure refractory to conventional treatments. During ECMO…

Extracorporeal Membrane Oxygenation for Cardiac Support

Objectives This chapter will: 1. Describe the general configuration and operating principles of a venous-arterial extracorporeal membrane oxygenation (ECMO) system. 2. Review the main indications for starting and stopping ECMO. 3. Detail specific pathophysiologic conditions of ECMO patients. 4. Discuss the possible side and negative effects of an ECMO treatment. Extracorporeal membrane oxygenation (ECMO) is an artificial extracorporeal therapy that consists of a specific heart-lung machine…

Plasmafiltration-Adsorption-Dialysis System

Objectives This chapter will: 1. Describe the possibility of combining convection, diffusion, and adsorption to improve the efficiency of extracorporeal depurative techniques. 2. Discuss the role of plasma as a substrate and a medium of blood purification. 3. Describe the use of the patient's plasma as “dialysate” to perform a new type of high-permeability-cutoff plasma dialysis. Molecules are present in the plasma dissolved in plasmatic water…

Toraymyxin and Other Endotoxin Adsorption Systems

Objectives This chapter will: 1. Describe the role of endotoxin in sepsis. 2. Discuss diagnostic approaches to endotoxin measurement. 3. Describe the history of endotoxin-targeted therapy in sepsis, from drugs to medical devices. 4. Discuss the characteristics of the Toraymyxin endotoxin adsorption system as well as other endotoxin removal systems. 5. Discuss the clinical data on Toraymyxin. 6. Discuss the preliminary results of the EUPHRATES trial…

Prometheus System

Objectives This chapter will: 1. Provide a description of the Prometheus extracorporeal liver support system. 2. Summarize available clinical data of Prometheus. 3. Compare Prometheus with MARS procedures. 4. Discuss the method, results, and possible indications. Patients with liver failure still have a high mortality if liver transplantation is not available in time. Therefore extracorporeal liver support devices have already been evaluated for a long time.…

Extracorporeal Blood Purification Techniques Beyond Dialysis: Coupled Plasmafiltration-Adsorption

Objectives This chapter will: 1. Discuss the use of extracorporeal blood purification techniques within the clinical picture of sepsis. 2. Provide a rationale based on in vitro and animal studies for the use of coupled plasmafiltration-adsorption in human sepsis. 3. Analyze clinical results of this approach in terms of hemodynamics, respiratory function, immune status, and survival. 4. Update the technical feature of the new machine and…

Therapeutic Apheresis in Critically Ill Patients: Indications, Modalities and Techniques, Clinical Results

Objectives This chapter will: 1. Identify pathophysiologic considerations for the application of therapeutic apheresis. 2. Describe the role and application of apheresis in critical care medicine. 3. List advantages and drawbacks of selective apheresis systems compared with plasma exchange. 4. Identify accepted indications for apheresis treatment. Therapeutic apheresis (TA) has been established more than 50 years by introducing therapeutic plasma exchange (TPE), a procedure that has…

Sorbents: From Basic Structure to Clinical Application

Objectives This chapter will: 1. Describe the nature, the structure, and the composition of sorbent materials. 2. Characterize the mechanisms of the adsorption process. 3. Describe the potential application of sorbents in extracorporeal blood purification techniques. 4. Summarize some of the results achieved by the use of sorbents in specific clinical syndromes. Solute removal in hemodialysis and other blood purification techniques is achieved mainly by diffusion…

Nursing and Procedure Issues in Peritoneal Dialysis

Objectives This chapter will: 1. Describe the role of peritoneal dialysis in management of acute kidney injury (AKI). 2. Describe the procedure for performing acute peritoneal dialysis (PD) in management of AKI. 3. Discuss the role and importance of nursing team in acute PD. The use of peritoneal dialysis (PD) remains relevant in the setting of acute kidney injury (AKI), particularly in the developing world. Various…

Continuous-Flow Peritoneal Dialysis as Acute Therapy

Objectives This chapter will: 1. Elucidate the rationale for continuous-flow peritoneal dialysis and its underlying physiology. 2. Review the historical perspective of continuous-flow peritoneal dialysis. 3. Discuss the techniques of this modality: single-pass versus recirculation, dual-lumen catheter versus two catheters, ultrafiltration control, and dose of dialysis. 4. Review the special considerations in and clinical experience of continuous-flow peritoneal dialysis in pediatric acute renal failure. 5. Describe…

Comparison of Peritoneal Dialysis With Other Treatments for Acute Kidney Injury

Objectives This chapter will: 1. Examine solute and volume control using peritoneal dialysis in critically ill acute kidney injury patients. 2. Compare peritoneal dialysis with other forms of renal replacement therapy in critically ill acute kidney injury patients in regard to outcomes. 3. Examine the differences in cost for peritoneal dialysis in critically ill acute kidney injury patients. 4. Compare the risks and benefits that peritoneal…

Treatment of Peritonitis and Other Clinical Complications of Peritoneal Dialysis in the Critically Ill Patient

Objectives This chapter will: 1. Discuss the major complications of peritoneal dialysis pertinent to critical care. 2. Describe the principles underlying the management of these complications. 3. Review preventive measures to minimize complications in this population. Peritoneal dialysis (PD) is a simple but effective treatment of renal failure that relies on the peritoneal membrane for solute clearance and ultrafiltration. The major complications of PD can be…

Clinical Results and Complications of Peritoneal Dialysis in Acute Kidney Injury

Objectives This chapter will: 1. Explore the role that peritoneal dialysis may play in the management of acute kidney injury in the current era. 2. Discuss some of the clinical trials of peritoneal dialysis in acute injury vis à vis the other modalities of treatment, namely, intermittent hemodialysis and continuous renal replacement therapy. 3. Describe the complications of acute peritoneal dialysis. Acute kidney injury (AKI) is…

Feasibility, Efficiency, and Adequacy of Peritoneal Dialysis in Acute Kidney Injury

Objectives This chapter will: 1. Explain the overall role of peritoneal dialysis in acute kidney injury. 2. Describe the concept of dialysis dose and efficiency as it relates to peritoneal dialysis. 3. Discuss the shortcomings of urea kinetics in assessing the adequacy of dialysis dose in acute kidney injury. 4. Define the adequacy of peritoneal dialysis dose through the compound measures of the individual components in…

Correction of Fluid, Electrolyte, and Acid-Base Derangements by Peritoneal Dialysis in Acute Kidney Injury

Objectives This chapter will: 1. Describe the key components of an acute peritoneal dialysis prescription in patients with acute kidney injury in the intensive care unit. 2. Explore the role of acute peritoneal dialysis in the management of patients with volume overload in the intensive care unit. 3. Discuss the correction of electrolyte abnormalities with the use of acute peritoneal dialysis. 4. Summarize the role of…