Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 16;10(1):96.
doi: 10.1186/s13613-020-00714-3.

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

Valentin Fuhrmann  1   2 , Theresa Weber  3 , Kevin Roedl  3 , Jasmin Motaabbed  4 , Adel Tariparast  3 , Dominik Jarczak  3 , Aritz Perez Ruiz de Garibay  5 , Johannes Kluwe  6 , Olaf Boenisch  3 , Harald Herkner  7 , John A Kellum  8 , Stefan Kluge  3
Affiliations

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

Valentin Fuhrmann et al. Ann Intensive Care. .

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.

Keywords: ARDS; Acidosis; Acute liver failure; Albumin dialysis; Extracorporeal organ support; Multiple organ failure; Septic shock.

PubMed Disclaimer

Conflict of interest statement

VF receives speaker fees from Advitos, OB receives speaker fees from Advitos, others have nothing to declare.

Figures

Fig. 1
Fig. 1
The ADVOS system
Fig. 2
Fig. 2
Dialysate blood flow rate, dialysate pH setting of the ADVOS device impact the pH-difference between inlet and outlet (delta pH)
See this image and copyright information in PMC

References

    1. Vincent J-L, Lefrant J-Y, Kotfis K, Nanchal R, Martin-Loeches I, Wittebole X, et al. Comparison of European ICU patients in, 2002 (ICON) versus 2002 (SOAP. Intensive Care Med. 2012 doi: 10.1007/s00134-017-5043-2. - DOI - PMC - PubMed
    1. Vincent J-L, Nelson DR, Williams MD. Is worsening multiple organ failure the cause of death in patients with severe sepsis? Crit Care Med. 2011;39:1050–1055. doi: 10.1097/CCM.0b013e31820eda29. - DOI - PubMed
    1. Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–1423. doi: 10.1007/s00134-015-3934-7. - DOI - PubMed
    1. Drolz A, Horvatits T, Roedl K, Rutter K, Staufer K, Haider DG, et al. Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit. Ann Intensive Care. 2016;6:61. doi: 10.1186/s13613-016-0162-4. - DOI - PMC - PubMed
    1. Staufer K, Roedl K, Kivaranovic D, Drolz A, Horvatits T, Rasoul-Rockenschaub S, et al. Renal replacement therapy in critically ill liver cirrhotic patients-outcome and clinical implications. Liver Int. 2017;37:843–850. doi: 10.1111/liv.13389. - DOI - PubMed