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The patients with respiratory failure need high tidal volume by mechanical ventilation, which lead to the ventilator-induced lung injury. We developed an extracorporeal lung and renal assist device (ELRAD), comprising acid infusion, membrane lung, continuous hemodiafiltration and alkaline infusion. To evaluate this system, we conducted in vivo studies using experimental swine which were connected to the new system. In vivo experiments consist of four protocols; baseline = hemodiafiltration only (no O2 gas flow to membrane lung); membrane lung = “Baseline” plus O2 gas flow to membrane lung; “Acid infusion” = “Membrane lung” plus continuous acid infusion; ELRAD = “Acid infusion” plus continuous alkaline infusion. We changed the ventilatory rate of the mechanical ventilation to maintain PCO2 at 50–55 mmHg during the four protocols. The results showed that there was statistically no significant difference in the levels of pH, HCO3−, and base excess when each study protocol was initiated. The amount of CO2 eliminated by the membrane lung significantly increased by 1.6 times in the acid infusion protocol and the ELRAD protocol compared to the conventional membrane lung protocol. Minute ventilation in the ELRAD protocol significantly decreased by 0.5 times compared with the hemodiafiltration only protocol (P

Background We examined whether high lactate level in septic patients was associated with 90-day mortality based on the patients’ disseminated intravascular coagulation (DIC) status. Methods We conducted a multicenter, retrospective, observational study of patients admitted to the intensive care unit (ICU) with a suspicion of severe infection and diagnosed with sepsis. Regression analyses were performed to estimate the interaction effect between DIC status and the lactate level. Then, the association between the lactate level and 90-day mortality was assessed in the DIC and non-DIC subgroups. Results The data of 415 patients were analyzed. We found a significant interaction between DIC status and the lactate level for predicting 90-day mortality (p interaction = 0.04). Therefore, we performed a subgroup analysis and found that high lactate concentration was significantly associated with 90-day mortality in the DIC group (odds ratio = 2.31, p = 0.039) but not in the non-DIC group. Conclusions In patients with DIC, a high lactate level significantly predicted 90-day mortality; no such association was found in the non-DIC group. Thus, DIC status may serve as a possible effect modifier of lactate level in predicting mortality in patients with sepsis.

The usefulness of extracorporeal membrane oxygenation (ECMO) is being rediscovered in the wake of the pandemic of H1N1 influenza. However, it has been reported that patients who received ECMO often developed virus-associated hemophagocytic syndrome (VAHS), compared with those without ECMO support. Although there is ample evidence that extensive cytokine activation is a key factor in VAHS, ECMO itself could be a potential trigger to exacerbate the pathology by amplifying cytokine activation. In this study, we investigated whether mediators such as cytokines may be produced by ECMO.

At ISICEM 2011, we reported that AN69ST showed the highest capacity to adsorb high mobility group box 1 protein (HMGB1) when compared with polymethylmethacrylate, polysulfone and high cut-off membrane [1]. Here we focus on whether filtration or surface heparin on AN69ST by a priming circuit with a heparinized saline contributes to HMGB1, with a heparin-binding protein, adsorption on AN69ST.

Sustained high-efficiency daily hemodiafiltration using a cytokine-adsorbing membrane (SHEDD-fA) is an effective modality for sepsis treatment. Here we describe the effectiveness of SHEDD-fA, which makes the best use of three principles for solute removal, in the treatment of severe sepsis.