Temperature monitoring in dialysis-induced hypotension.
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Biomedical subjects
Publications and source records attributed to S Lucatello.
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Among 55 uremic patients who entered our CAPD program, 7 of them showed a reduction or loss of the ultrafiltration capacity (UF) of the peritoneal membrane (PM). They have been treated with high dose of Furosemide (F) to force residual urine output. Four appeared "responders" to drug administration with a significant increase in urine volume, Na excretion and, within a week period gained their dry body weight (BW). In the remaining 3 patients drug therapy resulted ineffective, and fluid removal was obtained by hemofiltration (HF). In both groups we noted an increase in the UF capacity of PM when their dry BW was obtained either by pharmacological or technical approach. These results support the assumption that the over-hydration status of the PM plays a major role in maintaining the UF process.
Lysagth et al have reported a semplified model of spontaneous plasmapheresis by placing between an A-V shunt a conventional plasmafilter. On the basis of this experience we tried to make a further semplification of this apparatus using a single venous puncture, obtaining by gravity sufficient transmembrane pressure for plasma separation. By alternatively lowering and elevating the system, plasma is separated from the blood and packed red cells are reinfused after a new pass through the filter with FFP or plasma substitutes.
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Vascular instability represents the most frequent intradialytic complication of uremic patients. Catecholamine impairment, changes in plasma sodium or osmolality and, more recently, temperature (T) of dialysate have been proposed to explain this phenomenon. In order to evaluate the role of T in hemodynamic stability, we studied the effect of cooling dialysate in 5 patients (3 m, 2 f), who often experienced hypotension during dialytic sessions. Dialysate T was lowered, leading to a body T decrease of 1.5 degrees C, measured by a thermistor in the pulmonary artery. Ultrafiltration was kept constant during both "warm" (W) and "cold" (C) hemodialysis (HD). Systemic and pulmonary hemodynamic parameters were studied by thermodilution technique. The evaluation was performed in the same patients during W-HD and C-HD with the same dialysate composition. MAP showed a significant reduction during the first hour under both dialysis conditions. Subsequently a further decrease of MAP was observed in W-HD, while it remained stable in C-HD. CI and SI demonstrated similar trends, whereas HR showed no major changes. TPRI appeared significantly higher during C-HD compared to W-HD, with no clinical symptoms of hypotension. Similarly pulmonary parameters resulted in a better cardiovascular stability during C-HD. Our hemodynamic study confirms the important role played by T on intradialytic vascular stability and may explain the better control observed during hemofiltration compared to standard W-HD.
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Despite the great impact of continuous ambulatory peritoneal dialysis (CAPD) as an effective modality of treatment for uraemic patients, two limiting factors remain: the high incidence of peritonitis and the need for patients continuously to carry a bag. We have designed a new closed system with two bags connected to the permanent Tenckhoff catheter. Two clamps alternately allow outflow and inflow of peritoneal dialysate. When the exchange manoeuvre is finished the patient frees the whole system from the needle and discards it. Since December 1978, 24 patients have been treated with this technique. The results are similar to the Toronto series with a marked reduction in the incidence of peritonitis (22.5 pt/months).
A new technical approach has been described for the treatment of patients on CAPD. The new approach is based on the use of a two-bag system and closed connection by a connector to the Tenckhoff catheter. After each dialyzate exchange the patient discards the entire system and is completely bag-free, unlike the Oreopoulos CAPD technique. Using this new procedure we have markedly reduced the incidence of peritonitis and we have made the patient free from carrying an uncomfortable burden during the interval of solution exchange.
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