Service of Intensive Care, Centre Hospitalier du Centre du Valais, Sion, Switzerland.
Nephrol Dial Transplant. 2011 Feb;26(2):628-35. doi: 10.1093/ndt/gfq449. Epub 2010 Jul 28.
Continuous renal replacement therapy (CRRT) has been increasingly used in critically ill patients with acute kidney injury (AKI). One of the major properties that likely influence the catheter lifespan includes its surface specificity. We hypothesized that the improvement of blood-surface interaction by a reactive polymer film coating might reduce thrombogenic events in the vascular access device and subsequently lead to prolonged catheter survival in this clinical setting.
We compared, in a randomized study, the clinical application of two temporary catheters (TCs): one surface-modified double-lumen catheter (smDLC) and one standard sDLC with identical geometry and flow design. Efficacy end points were defined as the ability to complete at least 72 h CRRT without interruption due to TC dysfunction and ability to achieve blood flow rates of ≥150 mL/min. Safety end points were defined as the occurrence of catheter-related (CR) bacteraemia or other CR complications.
We evaluated 236 critically ill patients (264 TCs) with AKI on CRRT (continuous venovenous haemodiafiltration) with age (mean±SD) of 56.9±17.9 years. The clinical investigation revealed that the number of hours before TC removal according to clinical requirements was significantly higher with smDLC as compared with sDLC (131±38 vs 113±21 h; P=0.004). Temporary catheter dysfunction occurred in 5% for smDLC and 14% for sDLC; P=0.001. Thrombosis of smDLC and sDLC was observed in 2.3 episodes per 1000 TC-days [95% confidence interval (CI), 1.9-2.5] and 4.2 episodes per 1000 TC-days (95% CI, 4.0-4.4), respectively; P=0.021. The blood flow rate was 221±29 mL/min vs 187±36 mL/min for smDLC and sDLC, respectively; P=0.012. Compared with the overall mean of TC dysfunction or thrombosis, the relative risk of premature removal (<72 h) was 0.43 (95% CI, 0.13-0.98; P=0.041) for smDLC and 2.51 (95% CI, 1.04-9.22; P=0.034) for sDLC with a significantly higher catheter-related bacteraemia rate in this latter group (P=0.008).
Micropatterned surface coating with a polyurethane polymer significantly increased TC survival with lower dysfunction rate, lower thrombotic events and better bacteriological barrier than sDLC in critically ill patients with AKI necessitating CRRT.
连续肾脏替代疗法（CRRT）已越来越多地应用于急性肾损伤（AKI）的危重病患者。可能影响导管寿命的主要特性之一是其表面特异性。我们假设通过反应性聚合物膜涂层改善血液-表面相互作用可能会减少血管通路装置中的血栓形成事件，并随后导致在这种临床环境中导管的存活时间延长。
我们在一项随机研究中比较了两种临时导管（TC）的临床应用：一种表面改性双腔导管（smDLC）和一种具有相同几何形状和流动设计的标准 sDLC。疗效终点定义为能够在不由于 TC 功能障碍而中断的情况下完成至少 72 小时的 CRRT，并能够达到≥150 mL/min 的血流速度。安全性终点定义为导管相关性（CR）菌血症或其他 CR 并发症的发生。
我们评估了 236 名接受 CRRT（连续静脉-静脉血液滤过）的 AKI 危重病患者（264 个 TC），年龄（平均值±标准差）为 56.9±17.9 岁。临床研究显示，根据临床要求移除 TC 之前的小时数明显高于 smDLC（131±38 小时与 113±21 小时；P=0.004）。smDLC 出现 TC 功能障碍的比例为 5%，sDLC 为 14%；P=0.001。smDLC 和 sDLC 的血栓形成分别观察到每 1000 TC 天 2.3 例[95%置信区间（CI），1.9-2.5]和 4.2 例[95%CI，4.0-4.4]；P=0.021。smDLC 和 sDLC 的血流速度分别为 221±29 mL/min 和 187±36 mL/min；P=0.012。与 TC 功能障碍或血栓形成的总体平均值相比，smDLC 的提前移除（<72 小时）的相对风险为 0.43（95%CI，0.13-0.98；P=0.041），sDLC 为 2.51（95%CI，1.04-9.22；P=0.034），后一组的导管相关性菌血症发生率明显更高（P=0.008）。
在需要 CRRT 的 AKI 危重病患者中，与 sDLC 相比，用聚氨酯聚合物进行微图案表面涂层可显著提高 TC 存活率，降低功能障碍率、血栓形成事件发生率，并改善细菌学屏障。
