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World Journal of Surgery | 1996

Blood Purification for Prevention and Treatment of Multiple Organ Failure

Hiroyuki Hirasawa; Takao Sugai; Yoshio Ohtake; Shigetoshi Oda; Kenichi Matsuda; Nobuya Kitamura

Abstract. Blood purification has been applied conventionally as an artificial kidney or artificial liver in the management of patients with multiple organ failure (MOF), and most blood purifications have been performed intermittently. Recent advances in medical engineering made it possible to perform such blood purifications continuously (i.e., 24 hours a day, 7 days a week if necessary) even in critically ill patients. This modality is referred to as continuous renal replacement therapy (CRRT) or continuous blood purification (CBP). Among many kinds of CBP, continuous hemodiafiltration (CHDF) is most useful for management of MOF, as it can be performed without serious or hazardous side effects, and improvement can be expected with it. Recently, CHDF and polymyxin B immobilized endotoxin adsorption columns were used for the prevention or treatment of MOF, with the expectation that such therapy can be effective as a countermeasure against the pathophysiologic causes of MOF. Our data and that of others clearly indicate that continuous blood purification, such as with CHDF and endotoxin adsorption, can remove or decrease the blood levels of humoral mediators, including proinflammatory cytokines, and can improve tissue oxygenation, especially oxygen consumption (VO 2 ) among critically ill patients including those with MOF. Blood purification is also useful in the careful management of fluid, electrolytes, and acid-base balance and for the removal of metabolic wastes. Blood purification is now considered to be one of the basic therapeutic tools of critical care, equal to nutritional support with total parenteral nutrition and respiratory support without a ventilator.


Renal Failure | 1983

Experimental and Clinical Study on ATP-MgCl2 Administration for Postischemic Acute Renal Failure

Hiroyuki Hirasawa; Michio Odaka; Kouji Soeda; Hirotada Kobayashi; Yoshio Ohtake; Shigeto Oda; Susumu Kobayashi; H. Sato

The present study was undertaken to investigate the effect of ATP-MgCl2 on the recovery of renal function following renal ischemia. Bilateral renal ischemia was produced for 90 minutes in dogs. Immediately after the release of ischemia, ATP-MgCl2 (50 mumoles/kg) was given intravenously. Serum creatinine and FeNa were measured following the release of ischemia. Renal cellular energy charge, glomerular endothelial thickness and per cent circularity of interstitial cells were measured. Creatinine and FeNa were significantly lower in ATP-MgCl2 treated dogs compared to those in saline treated controls. Changes in energy charge, glomerular endothelial thickness and per cent circularity indicated ischemically induced renal cellular edema was reversed with ATP-MgCl2 through the improvement of energy metabolism. Taking those experimental data into consideration, ATP-MgCl2 was given to 16 acute renal failure patients and 13 patients survived. ATP-MgCl2 administration is effective for the treatment of acute renal failure.


Jpn J Gastroenterol Surg, Nihon Shokaki Geka Gakkai zasshi | 1993

Nutritional Support for the Patient with Multiple Organ Failure in Gastroenterological Surgery.

Hiroyuki Hirasawa; Takao Sugai; Yoshio Ohtake; Shigeto Oda; Hidetoshi Shiga; Kazuya Nakanishi; Nobuya Kitamura; Hirokazu Ueno

消化器外科領域の多臓器不全 (multiple organ failure;MOF) 70例を対象に, いかにして代謝動態を把握し, いかなる栄養管理を施行すればよいかを検討した.代謝動態の把握には, indirect calorimetryによるエネルギ-消費量, respiratory quotient, %FAT, 動脈血中ケトン体比 (arterial ketone body ratio; AKBR) およびケトン体量, 血中乳酸値などが有効であった.MOF患者はhypermetabolicで, 基礎エネルギー消費量の140~150%を消費しており, AKBRの低下している肝不全合併MOF症例では, エネルギー基質の利用制限や蛋白代謝の低下が観察された.全症例に対して中心静脈栄養法を施行した.消費エネルギー量相当のエネルギ-量の投与は肝不全合併MOFおよび腎不全合併MOFで困難であったが, 前者ではATP-Mgやplasma exchangeの併用が, 後者では持続的血液濾過や持続的血液濾過透析の併用が有効であった.また分枝鎖アミノ酸を多量に含む製剤は有用であった.


Contributions To Nephrology | 1991

Nafamostat Mesylate as Anticoagulant in Continuous Hemofiltration and Continuous Hemodiafiltration

Yoshio Ohtake; Hiroyuki Hirasawa; Takao Sugai; Shigeto Oda; Hidetoshi Shiga; Kenichi Matsuda; Nobuya Kitamura


Contributions To Nephrology | 1991

Continuous Hemofiltration and Hemodiafiltrationin the Management of Multiple Organ Failure

Hiroyuki Hirasawa; Takao Sugai; Yoshio Ohtake; Shigeto Oda; Hidetoshi Shiga; Kenichi Matsuda; Nobuya Kitamura


Artificial Organs | 1988

Prognostic value of serum osmolality gap in patients with multiple organ failure treated with hemopurification.

Hiroyuki Hirasawa; Michio Odaka; Takao Sugai; Yoshio Ohtake; Hideo Inaba; Yoichiro Tabata; Hirotada Kobayashi; Kaichi Isono


Shock | 1996

CORRELATION BETWEEN THROMBOCYTOPENIA AND DEVELOPMENT OF MOF IN CRITICALLY ILL PATIENTS: 14

Hirokazu Ueno; Hiroyuki Hirasawa; Takao Sugai; Yoshio Ohtake; Shigeto Oda; Kazuya Nakanishi; Kenichi Matsuda; Nobuya Kitamura


Shock | 1995

CELLULAR INJURY SCORE (CIS) FOR THE SEVERITY INDEX OF SIRS AND MOF

Hiroyuki Hirasawa; Takao Sugai; Yoshio Ohtake; Shigeto Oda; Kazuya Nakanishi; Nobuya Kitamura; Kenichi Matsuda; Touichi Kawabe; Hirokazu Ueno; Tomohito Sadahiro; Kenji Yokohari; Takayuki Touma


Nihon Kyukyu Igakukai Zasshi | 1993

A Study on Arterial Ketone Body Ratio (AKBR) and Arterial Ketone Body Concentration (KBC) in Fulminant Hepatitis

Yoshio Ohtake; Hiroyuki Hirasawa; Takao Sugai; Shigeto Oda; Hidetoshi Shiga; Kazuya Nakanishi; Nobuya Kitamura


Jinko Zoki | 1983

A NEW MODALITY OF HEMOPURIFICATION USING DIRECT HEMOPERFUSION AND HEMODIALYSIS FOR THE TREATMENT OF RENAL FAILURE

Hiroyuki Hirasawa; Michio Odaka; Hirotada Kobayashi; Yoshio Ohtake; Shigeto Oda; Susumu Kobayashi; H. Satoh

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