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Open Access 01-12-2020 | Acute Liver Failure | Research

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Authors: Valentin Fuhrmann, Theresa Weber, Kevin Roedl, Jasmin Motaabbed, Adel Tariparast, Dominik Jarczak, Aritz Perez Ruiz de Garibay, Johannes Kluwe, Olaf Boenisch, Harald Herkner, John A. Kellum, Stefan Kluge

Published in: Annals of Intensive Care | Issue 1/2020

Abstract

Background

Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid–base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF.

Methods

34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acid–base regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2).

Results

Median number of treatment sessions was 2 (range 1–9) per patient. Median duration of treatment was 17.5 (IQR 11–23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO₃⁻ and PaCO₂, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO₃⁻ and PaCO₂ were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively.

Conclusions

In this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid–base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.

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Title: Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure
Authors: Valentin Fuhrmann
Theresa Weber
Kevin Roedl
Jasmin Motaabbed
Adel Tariparast
Dominik Jarczak
Aritz Perez Ruiz de Garibay
Johannes Kluwe
Olaf Boenisch
Harald Herkner
John A. Kellum
Stefan Kluge
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Acute Liver Failure
Septic Shock
Acidosis
Acute Respiratory Distress-Syndrome
Published in: Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-020-00714-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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