[Safety and efficacy of the MARS therapy applied by continuous renal replacement therapy (CRRT) monitors].
OBJECTIVE
Analyze the utility and safety of MARS therapy applied with the CRRT monitor.


METHODS
Prospective study of cohorts.


METHODS
Polyvalent ICU in tertiary university hospital with hepatic transplantation program.


METHODS
Thirty one patients: 9 (22.6%) with acute liver failure (ALF) (1 hepatic surgery, 1 primary graft failure, 7 other causes) and 22 (71%) with acute-on-chronic failure (AoCLF).


METHODS
For the treatment, the patients with ALF are maintained in the ICU but those with AoCLF are admitted for the performance of the different sessions, that are programmed for a duration of at least 15 hours in AoCLF and in ALF are maintained continuously, changing the circuit every 24 hours.


METHODS
Metabolic control and complications registered in 75 sessions on 31 patients.


RESULTS
Urea decrease was 33.5 (29-38%), creatinine 36 (31-41%), total bilirubin 29 (25-33%) and direct bilirubin 34 (30-38%). Clearance was slower, but sustained, after the first 4 hours of each session both for urea (p<0.001) as well as for bilirubin (p<0.05). The hemodynamic parameters improved and the hematological ones were not altered. We detected decrease in platelets (131 to 120x109/L, p<0.01). In 95 of the sessions in which heparin was used and in 6% where epoprostenol was used, we observed mild bleeding. We cultured albumin of the circuit at the end of the session in 50 occasions and only obtained growth in 3 cases (6%) (2 Staphylococcus epidermidis, 1 S. haemolyticus) without signs of contamination in the patients.


CONCLUSIONS
The MARS system applied by CRRT monitors provide adequate bilirubin clearance percentages and is safe, even in serious patients. Prolongation of the duration of the sessions was not accompanied by an increase in the risk of infection secondary to the albumin contamination.
Herrera-Gutiérrez
M E
ME
Cuidados Críticos y Urgencias, Complejo Hospitalario Universitario Carlos Haya, Málaga, Spain. mehguci@wanadoo.es
Seller-Pérez
G
G
Lebrón-Gallardo
M
M
Jiménez-Pérez
M
M
Moreno-López
J M
JM
Muñoz-López
A
A
D000327:Adsorption; D000328:Adult; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods*; D012449:Safety