Critical careとアフェレシス : 総論(歴史,分類)

概要

論文の詳細を見る
The historical background and classification of apheresis in critically ill patients are reviewed in this article. We can trace blood exchange as a kind of apheresis back to the Greeks and Romans in the 17th century. In 1914, the Johns Hopkins group investigated the possibility of apheresis and commented that they felt it appropriate to study plasma exchange. Thereafter, the membrane technology for dialysis and hollow fiber separation methodology have made apheresis, including plasma exchange, adsorption and hemodialysis, much more readily avilable for clinical use. In 1977, Kramer et al. reported CAVH for the management of acute renal failure in critically ill patients. Compared to hemodialysis, CAVH induces less hemodynamic instability, more gradual change in osmolarity with minimal complement activation and, of increasing importance, less need for specialized personnel. To overcome the shortcomings of CAVH, CHF and CHDF have been developed. In general, these techniques are indicated for acute renal failure patients with hemodynamic instability or severe fluid overload. These techniques are now widely applied for ICU patients on many occasions including ARDS or sepsis/MODS because they eliminate convectively inflammatory mediators. In 1980, Tani reprted the use of DHP with polymyxin-B immobilized fiber for the adsorption of endotoxin, and DHP has been available for clinical use in Japan since 1993. Continuous plasma exchange was developed to eliminate large amounts of toxins and to reduce various complications. Apheresis therapy is classified according to diagnostic indication (acute renal failure, acute hepatic failure, ARDS, sepsis/MODS, collagen disease, etc.), type of circuit and separator (filtration, dialysis, plasma exchange, adsorption, etc.), and type of blood access (e.g., CAVH orCVVH). It is concluded that the development of new apheresis therapies may improve the high mortality and morbidity rates in critically ill patients.
日本アフェレシス学会の論文
1999-02-28

Critical careとアフェレシス : 総論(歴史,分類)

スポンサーリンク

概要

著者

関連論文

スポンサーリンク