Hidroxietil-almidón como líquido de reemplazo enaféresis terapéutica: experiencia en una unidad decuidados intensivos
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Fecha
2024
Autores
Borre-Naranjo, Diana
Rico-Fontalvo, Jorge
Daza-Arnedo, Rodrigo
Daguer, David
Gamarra Mercado, Ángela María
Rodriguez Yanez, Tomas
Aguilar, Miguel
Rojas-Suarez, José
Ramos Terrales, Natalia
Soler, María José
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Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
Resumen
la enfermedad e interrumpir su progresión. El efluente de reemplazo para AT depende deltipo de enfermedad. Las más usadas son la albúmina (4% o 5%) y el plasma fresco congelado.Sin embargo, los expansores plasmáticos sintéticos como hidroxietil-almidón (HEA) (6%) se hanutilizado en AT.Objetivo: Describir la experiencia con el uso de HEA (al 6%) en la unidad de cuidados intensivos(UCI) como principal efluente de reemplazo.Materiales y métodos:Estudio descriptivo retrospectivo, desde el 1 de octubre de 2014 hastael 31 de diciembre de 2020, en una UCI de Cartagena, Colombia, en pacientes con indicación,por un nefrólogo, de inicio de AT según las guías de la Sociedad Americana de Aféresis (ASFA).La AT se realizó por filtración a través de la tecnología multifiltrate clásica (Fresenius Medical Care). El volumen de plasma se calculó mediante el método de Kaplan y la dosis de recambioplasmático fue de 1 a 1,5 veces el volumen plasmático estimado, con reemplazo isovolumétricoe isooncótico utilizando HEA al 6%, plasma fresco congelado (PFC) y cristaloides.Resultados: De 22 pacientes incluidos, 18 recibieron HEA al 6% como fluido de recambio prin-cipal. La mediana de edad fue de 44 a˜nos (32,3-64,5). Los pacientes presentaron hipertensión(n = 7 [31,8%]) y diabetes mellitus (n = 3 [13,6%]). Las principales indicaciones de AT fueron elsíndrome de Guillain-Barré (n = 18 [81,8%]) y la miastenia gravis (n = 18 [81,8%]). Las condicio-nes hematológicas y/o nefrológicas se registraron como indicación de AT en menor proporción(n = 4 [18%]). Al 6% fue administrado en pacientes con condiciones neurológicas. Se realizaron101 sesiones de AT: 87 con HEA al 6% y 14 con plasma fresco congelado (PFC). La seguridad dela AT con HEA al 6% se analizó con los valores de hemoglobina, recuento de plaquetas, coágulograma y creatinina (antes y después de las sesiones de AT).Conclusión: El uso de HEA como líquido de reemplazo para la AT resultó ser seguro y puede seruna alternativa al uso de la albúmina al 4% o al 5% como líquido de sustitución.© 2024 Asociaci´on Colombiana de Medicina Cr´ıtica y Cuidado lntensivo. Publicado por Else-vier Espa˜na, S.L.U. Se reservan todos los derechos, incluidos los de miner´ıa de texto y datos,entrenamiento de IA y tecnolog´ıas similares.
Introduction: Therapeutic apheresis (TA) enables the removal of disease-associated moleculesfrom plasma, thereby halting disease progression. The replacement effluent for TA depends onthe type of disease. The most used are albumin (4% or 5%) and fresh plasma. However, syntheticplasma expanders such as hydroxyethyl starch (6%) have been utilized in TA.Objective: To describe the experience with the use of hydroxyethyl starch (6%) in the intensivecare unit (ICU) as the primary replacement effluent.Materials and methods:A retrospective descriptive study was conducted from October 1, 2014,to December 31, 2020, in an ICU in Cartagena, Colombia, involving patients indicated by anephrologist to initiate TA according to the guidelines of the American Society for Apheresis(ASFA). Therapeutic apheresis was performed by filtration using the classic multifiltrate tech-nology (Fresenius Medical Care). Plasma volume was calculated using the Kaplan method, andthe plasma exchange dose was 1 to 1.5 times the estimated plasma volume, with isovolume-tric and iso-oncotic replacement using 6% hydroxyethyl starch, fresh frozen plasma (FFP), andcrystalloids.Results: Of the 22 patients included, 18 received 6% hydroxyethyl starch as the main replace-ment fluid. The median age was 44 years (32.3-64.5). Patients presented with hypertension (n = 7[31.8%]) and diabetes mellitus (n = 3 [13.6%]). The main indications for TA were Guillain-Barrésyndrome (n = 18 [81.8%]) and myasthenia gravis (n = 18 [81.8%]). Hematological and/or nephro-logical conditions were recorded as indications for TA in a smaller proportion (n = 4 [18%]). Sixpercent hydroxyethyl starch was administered to patients with neurological conditions. A totalof 101 TA sessions were performed: 87 with 6% hydroxyethyl starch and 14 with fresh frozenplasma (FFP). The safety of TA with 6% hydroxyethyl starch was analyzed using hemoglobinvalues, platelet count, coagulation profile, and creatinine levels (before and after TA sessions).Conclusion: The use of HES as a replacement fluid for therapeutic apheresis proved to be safeand may be an alternative to the use of 4% or 5% albumin as a substitution fluid.© 2024 Asociaci´on Colombiana de Medicina Cr´ıtica y Cuidado lntensivo. Published by ElsevierEspa˜na, S.L.U. All rights are reserved, including those for text and data mining, AI training, andsimilar technologies.
Introduction: Therapeutic apheresis (TA) enables the removal of disease-associated moleculesfrom plasma, thereby halting disease progression. The replacement effluent for TA depends onthe type of disease. The most used are albumin (4% or 5%) and fresh plasma. However, syntheticplasma expanders such as hydroxyethyl starch (6%) have been utilized in TA.Objective: To describe the experience with the use of hydroxyethyl starch (6%) in the intensivecare unit (ICU) as the primary replacement effluent.Materials and methods:A retrospective descriptive study was conducted from October 1, 2014,to December 31, 2020, in an ICU in Cartagena, Colombia, involving patients indicated by anephrologist to initiate TA according to the guidelines of the American Society for Apheresis(ASFA). Therapeutic apheresis was performed by filtration using the classic multifiltrate tech-nology (Fresenius Medical Care). Plasma volume was calculated using the Kaplan method, andthe plasma exchange dose was 1 to 1.5 times the estimated plasma volume, with isovolume-tric and iso-oncotic replacement using 6% hydroxyethyl starch, fresh frozen plasma (FFP), andcrystalloids.Results: Of the 22 patients included, 18 received 6% hydroxyethyl starch as the main replace-ment fluid. The median age was 44 years (32.3-64.5). Patients presented with hypertension (n = 7[31.8%]) and diabetes mellitus (n = 3 [13.6%]). The main indications for TA were Guillain-Barrésyndrome (n = 18 [81.8%]) and myasthenia gravis (n = 18 [81.8%]). Hematological and/or nephro-logical conditions were recorded as indications for TA in a smaller proportion (n = 4 [18%]). Sixpercent hydroxyethyl starch was administered to patients with neurological conditions. A totalof 101 TA sessions were performed: 87 with 6% hydroxyethyl starch and 14 with fresh frozenplasma (FFP). The safety of TA with 6% hydroxyethyl starch was analyzed using hemoglobinvalues, platelet count, coagulation profile, and creatinine levels (before and after TA sessions).Conclusion: The use of HES as a replacement fluid for therapeutic apheresis proved to be safeand may be an alternative to the use of 4% or 5% albumin as a substitution fluid.© 2024 Asociaci´on Colombiana de Medicina Cr´ıtica y Cuidado lntensivo. Published by ElsevierEspa˜na, S.L.U. All rights are reserved, including those for text and data mining, AI training, andsimilar technologies.
Descripción
Palabras clave
Terapia de recambio plasmático, Plasmaféresis, Hidroxietil-almidón
Citación
D. Borré-Naranjo, J. Rico-Fontalvo, R. Daza-Arnedo et al., Hidroxietil-almidón como líquido de reemplazo en aféresis terapéutica: experiencia en una unidad de cuidados intensivos, Acta Colombiana de Cuidado Intensivo, https://doi.org/10.1016/j.acci.2024.09.001
