key: cord-0883108-rlp873as
authors: nan
title: Abstracts der 52. Gemeinsamen Jahrestagung der DGIIN und ÖGIAIN
date: 2021-05-18
journal: Med Klin Intensivmed Notfmed
DOI: 10.1007/s00063-021-00827-y
sha: b0d48f1da4a96613999e87960966ff572361e758
doc_id: 883108
cord_uid: rlp873as

nan

Objective: Despite tremendous advances in the treatment of patients with systemic rheumatic diseases ( SRD), affected patients are at high risk for admission to the intensive care unit ( ICU). This is mostly due to infections, disease related complications or drug side effects. Data concerning these critically ill patients are limited to few retrospective studies on heterogenous populations. Primary aim of our study is to report a descriptive analysis on characteristics and outcome of our single center cohort of patients who were admitted to the ICU due to exacerbation of their underlying SRD. Method: Patients were included retrospectively between 01.01.2012 and 31.12.2020 at eleven ICU wards at the Vienna General Hospital. Potential eligible patients were identified with the AKH-Information-Management ( AKIM) EDV tool by selecting ICD-10 coded diagnoses. Results are reported by using median and interquartile ranges. Results: In total, 45 SRD patients (64.4 % women with a median age of 43 years [interquartile range ( IQR) 29-64 years]) were included. The median ICU length of stay was 13 days ( IQR 8-20 days). Connective tissue diseases (42.2 %) and vasculitides (42.2 %) accounted for the most common SRDs observed. 23 patients (51.1 %) already received immunosuppression prior to ICU admission. The leading cause for ICU admission was respiratory insufficiency (55.6 %), followed by shock (15.6 %) and neurological impairment (8.9 %). Median SOFA-, SAPSII-and APACHEII-Score on day 1 were 9 (IQR6-11), 34 (26.8-42 and 16 (13.8-25.5 ), respectively. In total 77.8 % of all patients required mechanical invasive ventilation ( MIV) with a median length of MIV of 12 days . Furthermore, 75.6 % of all patients received vasopressor therapy, in 44.4 % renal replacement therapy was conducted. Extracorporeal membrane oxygenation ( ECMO) was performed in 10 of 45 patients (22.2 %). Overall ICU mortality was 24.4 %, the 6-month mortality was 33.3 %. ICU readmission was required in 9 of 45 patients (20 %). ECMO patients had a 40 % survival rate at ICU discharge. Conclusion: In conclusion, patients admitted to the ICU due to SRD exacerbation still represent a major clinical challenge. Connective tissues diseases and vasculitides are the most common rheumatic entities requiring ICU treatment. Respiratory failure is the leading cause of ICU admission, a fact that is also reflected by high rates of required MIV and ECMO therapy. The lack of consistent data highlights the need for further research concerning prognostic parameters and more specific guidelines in treating these critically ill patients. Plasma eGC degradation products such as heparan-sulfate ( HS) and the eGC regulating enzymes, heparanase (Hpa)-1 and Hpa-2, were obtained before and after TPE. A 3D microfluidic flow assay was performed to examine the effect of TPE on eGC ex vivo. Results were compared to healthy controls. Results: SDF demonstrated a marked decrease in eGC thickness in septic patients compared to healthy individuals (p = 0.001). Circulating HS levels were increased more than six-fold compared to controls and decreased significantly following TPE (controls: 16.9 (8-18.6) vs. septic patients before ) µg/ml, p < 0.001; vs. after TPE: 70.7 (36.9-109.5) µg/ml, p < 0.001). The Hpa-2/Hpa-1 ratio was markedly reduced in septic patients before TPE but normalized after TPE (controls: 13.6 (6.2-21.2)

The patient's condition improved rapidly during PLEX. The patient could be weaned of the HFNO at day 6 (. Fig. 1 ). Viremia lasted until day 4. COVID-19 specific antibodies ( IgA and IgG) were positive after the first PLEX with a further increase of titer until day 28 (. Fig. 2) . ANCA and pro-inflammatory cytokines were cleared sufficiently. The patient was discharged on day 16. The patient received 120 mg prednisolone qd on discharge with continued tapering in the further course. Conclusion: In the present case of acute AAV, severe COVID-19 pneumonia and depletion of B-cells after RTX, which implies insufficient humoral immune response to SARS-CoV-2, PLEX treatment with CCP as the substitute was performed. We achieved sufficient clearing of the ANCA and pro-inflammatory cytokines. In addition, we were able to generate a sufficiently high titer of anti-SARS-CoV-2 antibodies to control COVID-19 pneumonia. We show that therapeutic plasma exchange with CCP is safe and feasible, and it has led to a significant improvement of the clinical situation.

Effects of therapeutic plasma exchange on the endothelial glycocalyx in septic shock K. Stahl Objective: Disruption of the endothelial glycocalyx (eGC) is observed in septic patients and its injury is associated with multiple-organ failure and inferior outcomes. Besides this biomarker function, increased blood concentrations of shedded eGC constituents might play a mechanistic role in septic organ failure. We hypothesized that therapeutic plasma exchange ( TPE) against fresh frozen plasma might influence eGC related pathology. Method: We enrolled 20 norepinephrine dependent ( NE > 0.4 mg/kg/min) patients with early septic shock (onset < 12 h). Sublingual assessment of the eGC via sublingual sidestream darkfield ( SDF) imaging was performed. schutz und die Informationsfreiheit und der lokalen Datenschutzbeauftragten und Ethikkommission beraten. Zusammenfassung: Die Digitalisierung der Infektionsforschung hat innerhalb der letzten 12 Monate deutliche Impulse bekommen. Das Forschungsprojekt KADOIN zeigt beispielhaft, dass eine ergebnisorientierte Kooperation von Medizinern und IT-Spezialisten praxisnahe Lösungen initiieren können, um pandemische Szenarien besser kontrollieren und das Gesundheitssystem entlasten zu können. Studienergebnisse zur Machbarkeit, Akzeptanz und Effektivität von KADOIN sind aufgrund der Aktualität vorläufig und werden im Rahmen der Jahrestagung präsentiert (. Abb. 1).

An outpatient management strategy using remote digital monitoring and Coronataxi home care significantly reduces COVID-19 mortality rate A. Lim, T. Hippchen, A. Welker 1 , M. Weigand 2 , U. Merle Gastroenterologie, Infektionskrankheiten, Vergiftungen, Klinik für Innere Medizin IV, Universitätsklinikum Heidelberg, Heidelberg; 1 Gesundheitsamt Rhein-Neckar-Kreis, Heidelberg; 2 Klinik für Anästhesiologie, Medizinische Fakultät, Ruprecht-Karls-Universität Heidelberg, Heidelberg;

Objective: The COVID-19 pandemic has caused great strain to healthcare systems and hospitals worldwide. Better outpatient management is required to prepare for future global pandemics. Hypoxemia due to COVID-19 occurs long before patients complain of subjective dyspnea and seek medical attention. Delayed medical attention and therapy likely result in higher rates of mechanical ventilation and mortality. Although many strategies to manage COVID-19 outpatients have been applied, there is currently limited information on their effectiveness. A new strategy combining remote digital monitoring and home quarantine visits for COVID-19 outpatients when indicated was implemented to optimize hospitalization rate and reduce mortality. The aim of this study is to measure the effectiveness of this new outpatient care system for COVID-19 in reducing mortality rate. Method: This system consisted of a call-center to obtain patients' medical history and current symptoms, a delivery system to bring pulse oxymeters to the patients after initial contact with the call-center, a mobile application (Huma-Medopad®) for remote monitoring of self-reported symptoms and oxygen saturation thrice daily and a nursing team that makes additional visits in home quarantine, if indicated. Upon diagnosis, the regional health authority informed COVID-19 patients regarding this outpatient care program, especially encouraging participation from patients with known risk factors for severe . Patients keyed in their peripheral oxygen saturation, heart rate, blood pressure, temperature and symptom progression into the app (Huma-Medopad®) regularly. A physician remotely monitored these data, advised patients accordingly and initiated additional home care visits with blood analysis at their discretion. The mortality rates obtained from the local health authorities were compared between this cohort and neighboring areas. Results: 451 patients were included in this study. Mortality rate was lower (0.67 % vs. 2.17 %, 2.22 %, 2.23 % and 2.71 % in this cohort vs neighboring areas) in this cohort with early digital monitoring. All 3 deaths in this monitored cohort appeared in elderly patients who refused intensive care treatment. The hospitalization rate was 14.86 % with a median of 4(6-9) days. Conclusion: We conclude that early remote digital monitoring and application of this system significantly reduces COVID-19 mortality. This model of outpatient care may be applied to other pandemics and is suited for use with highly infectious diseases in order to improve patient outcome and optimize resource allocation. vs. septic patients at inclusion: 2.9 (2.1-5.7), p = 0.001; vs. septic patients after TPE: 13.2 (11.2-31.8), p < 0.001; . Fig. 1) . Ex vivo stimulation of endothelial cells with serum from septic patients induced eGC damage that could be attenuated with serum post TPE (. Fig. 2) . Conclusion: Septic shock results in profound degradation of the eGC and an acquired deficiency of the protective regulator Hpa-2. TPE removed potentially injurious eGC degradation products and partially attenuated Hpa-2 deficiency. 

Schwere Bleivergiftung durch ayurvedisches Heilmittel C. Scherbaum, K. Lemberg, I. Tappert 1 , T. Frank 1 , C. Hüser, M. Hackl, V. Burst, V. Suárez Nephrologie, Rheumatologie, Diabetologie und phohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear. Method: Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation. Results: Secondary haemophagocytic lymphohistiocytosis due to severe COVID-19 was diagnosed via HScore. A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered. One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased. Conclusion: A routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality (. Fig. 1 ). Abb. 2 | P21 8 significant difference in survival nor ischemic events between patients with low and high on-treatment platelet reactivity (. Fig. 1 and 2) . Conclusion: Lower on-treatment ADP-induced platelet aggregation was independently associated with severe bleeding events in patients with AMI-CS. After one year, mortality rates were similar in both groups (55 % in conventional vs. 59 % in Impella CP group, p = 0.30) as was mortality rate at long-term 5-years follow-up (64 % in conventional vs. 73 % in Impella CP group, p = 0.33). The rate of clinically significant bleedings during ICU stay was lower in the conventional group than in the Impella support group (15 % vs. 43 %, p = 0.002). Conclusion: In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock. Objective: VA-ECMO is a promising option in cardiogenic shock ( CS) and as an extended resuscitation procedure (eCPR). However, the elevation in left ventricular afterload may increase myocardial wall stress, myocardial oxygen consumption and LV distention and enhances further reduction of LV contractility and pulmonary edema. Aim of this study was to evaluate pulmonary edema based on the RALE score [1] in patients receiving VA-ECMO therapy and the prognostic value of the score on ECLS-weaning and ICU mortality.

The association of bleeding events with respect to ADP-induced platelet aggregation was investigated in patients undergoing primary PCI for acute myocardial infarction complicated by cardiogenic shock ( AMI-CS) and with available on-treatment ADP-induced platelet aggregation measurements. , p = 0.01) were higher than in the controls. In multiple regression analysis, COVID-19 was independently associated with higher cfPWV (β = 3.164, p = 0.004) and baPWV (β = 3.532, p = 0.003). PWV values were higher in non-survivors. In survivors, PWV correlated with length of hospital stay. Conclusion: COVID-19 appears to be related to an enhanced PWV reflecting an increase in arterial stiffness. Higher PWV might be related to an increased length of hospital stay and mortality (. Abb. 1). vasopressor-dependent at study entry. The mean of the observed differences for the cardiac output index ( COI) was 0.7 l*min −1 *m −2 and the lower and upper 95 % limit of agreement were −1.9 and 3.3 l*min −1 *m −2 , respectively (. Fig. 1) .

The 95 % confidence interval for the limits of agreement was ±0.26 l*min −1 *m −2 , the percentage error 83.6 %. We observed concordant changes in CO with MG and PiCCO® in 50 % of the measurements after a fluid challenge and over the course of six hours. Conclusion: CO calculation with a novel oscillometry-based pulse wave analysis method is feasible and replicable in critically ill patients. However, we did not observe clinically applicable agreement between MG and thermodilution assessed with established evaluation routine using Bland-Altman approach and with trending analysis methods. In summary, we do not recommend to use this method in critically ill patients currently. As the basic approach is promising and the performance of CO calculation with MG very simple, further studies should be performed in hemodynamic stable patients and in critical care setting in order to perform further adjustments to the algorithm. 

M. Fischer, U. Kahl, Y. Yu, A. Nierhaus, D. Frings, B. Sensen, A. Objective: Extracorporeal lung support includes the risk of hemolysis caused by negative suction pressures in the case of high blood flow rates. Previous studies have paid little attention to the relationship between blood flows and pressure-drops. Manufacturers of extracorporeal gas exchange devices measure the pressure-drop across drainage cannulas for their products in vitro, using water instead of blood. Clinical experience suggests that hemolysis occurs in vivo already at a much lower flow rates.

The aim of this clinical study was therefore to systematically collect and analyze the in vivo pressure-drop relationship for VV-ECMO cannulas observed in the clinical routine. Method: Prospective, observational study at a medical intensive care unit at a tertiary care, university-level hospital. 14 patients that had to be put on veno-venous extracorporeal membrane oxygenation ( VV-ECMO) for severe ARDS were prospectively included.

In vitro, the 25 Fr drainage cannula pressure drops below a critical level of around −100 mmHg at a flow rate of 7.9 L/min, the 23 Fr drainage cannula at 6.6 L/min. In the clinical setting, critical suction pressures were reached at much lower flow rates (5.5 and 4.7 L/min; p < 0.0001, non-linear regression). The in vitro data largely overestimate the safely achievable flow rates in daily clinical practice by 2.4 L/min (or 44 %, 25 Fr) and 1.9 L/min (or 41 %, 23 Fr; . Fig. 1) . Conclusion: In vivo measurement of pressure-drop curves of venous drainage cannulas differed significantly from in vitro derived measurements during veno-venous membrane oxygenation as the latter largely underestimate the resulting pressure-drop. Objective: The aim of this phase III randomized controlled registration trial was to evaluate efficacy and safety of sedation with isoflurane administered via the anesthetic conserving device. Method: After ethical approval (Ärztekammer des Saarlandes, 11/17), trial registration (Eudra CT#: 2016-004551-67), and written informed consent, 21 German and 3 Slovenian study sites included 300 patients, randomized to either isoflurane (Sedaconda®, Sedana Medical, Danderyd, Sweden) or propofol for up to 48 ± 6 hours or until extubation. Richmond Agitation and Sedation Scale ( RASS) Scores were recorded two-hourly or before dose changes. Sedation efficacy was assessed as the proportion of time within RASS-1 to RASS -4 (primary endpoint) with a pre-defined noninferiority margin of −15 % relative to the mean for propofol. Secondary efficacy endpoints included opioid dosing, wake-up and extubation times. Safety endpoints included adverse events, lab values, vital signs, ventilator, ICU and delirium free days, and proportion of time with spontaneous breathing. Results: 301 critically ill patients were enrolled (isoflurane vs propofol, mean± SD: age 66 ± 12 vs 64 ± 13 years, SAPS-II: 42 ± 17 vs 44 ± 19, emergencies 65 % vs 65 %). The percentage of time within the target RASS range was similar for both groups (mean 〈 CI〉: 91 % 〈87-95〉 vs 91 % 〈87-95〉;

. Fig. 1 ) von 2018-2020, die für einen Zeitraum von mindestens 7 Tagen invasiv beatmet wurden, anhand des Atemwegszugangs der OTI-oder der NTI-Gruppe zugeordnet. Aus der elektronischen Datenbank wurden u. a. Beatmungsform, Dosis der Analgosedierung (Sufentanil, Propofol, Midazolam) und Richmond-Agitation-Sedation-Scale ( RASS) an Tag 1, 5, und 10 nach Intubation extrahiert und mittels gemischter linearer Modelle analysiert. Ergebnisse: Es wurden 79 Patienten mit NTI und 455 mit OTI ausgewertet, die sich in Bezug auf Krankheitsschwere ( SAPS-DRG NTI: 41 ± 10 vs. OTI: 44 ± 13, n. s.) und demographische Parameter nicht unterschieden. Die NTI Gruppe atmete an Tag 1 bis Tag 10 jeweils häufiger spontan (Mittelwert, 95 %Konfidenzintervalle): an Tag 1 atmeten 28 % (21;24) der NTI Gruppe spontan und 8 % (6;11) der OTI Gruppe, p < 0,001, an Tag 5 waren es 42 % (36;49) versus 27 % (24;30), p < 0,001 und an Tag 10 48 % (40;56) versus 37 % (24;41), p < 0,05. Patienten der NTI Gruppe waren weniger stark sediert: RASS Tag 1: −2,8 (−3,1;−2,5) versus −3,2 (−3,4;−3,1), Tag 5: −2,0 (−2,3;−1,7) versus −2,6 (−2,7;−2,5), Tag 10: −1,5 (−1,9;−1,1) versus −2,0 (−2,2;−1,9), jeweils p < 0,01 und erhielten weniger Sufentanil: an Tag trol Lifepak CR-T) close to the manikin. We asked passersby: Imagine a 50 year old man collapsed in front of you and lies here. What would you do? Using a predefined protocol we analysed the order, point of time and quality of measures of the first responders. After the first session, we defined a control and intervention group to rule out bias by anxiety. The allocation to the group was defined by lot. For the intervention group we did a standardised teaching for 90 seconds using a poster and short demonstration. The control group had 90 seconds to reflect their action. We started a second session for both groups with the same setting and evaluation protocol. The results of both sessions and groups were compared and analysed. Results: Of 189 participants (age: 18-80y) only 22 % did a correct assessment of the cardiac arrest in time. 84 % called the correct emergency number. Only 17 % did effective chest compressions. 28 % brought the patient in a stable lateral position without compressions. The AED was used by only 10 % of all first responders.

After the short teaching we saw a significant (p < 0,01) improvement of correct assessment of the cardiac arrest in time (81 %) and effective chest compressions (80 %). Only 1,2 % brought the patient in a stable lateral position without compressions. The AED was used by 68 % of all responders with a correct use of 92 %. No significant change was seen in the control group 0.33〉 vs 0.32 〈0.21-0.42〉 Mo-Eq/kg/h, p = 0.004) and spontaneous breathing was more frequent on day 1 (50 % vs 37 %, p = 0.013). Safety endpoints did not show any major differences of note. Conclusion: SEDACONDA is efficacious as a primary sole sedative, in the same efficacy range as propofol. Opioid requirements are lower and spontaneous breathing more common during isoflurane than during propofol sedation. The times to wake-up and extubation are short and predictable.

No new safety concerns arose for isoflurane given in subanesthetic doses for sedation in the ICU.

Early identification of patients with chest pain at very low risk of acute myocardial infarction using clinical information and ECG only K. Tscherny, C. Kienbacher, V. Fuhrmann, W. Schreiber, H. Herkner, D Fig. 1) . Patients with progressive disease at the time of aSCT had significantly impaired survival as well (p = 0.006) Baseline characteristics such as age and gender did not impact the outcome Only 2 of 39 patients who required MV were alive at 1 year. None of the patients in whom cardiopulmonary resuscitation (n = 12) or RRT (n = 19) was necessary were alive at 1 year. Among patients who died after discharge from the ICU (n = 23), infectious complications represented the major cause of death (48 %). Relapse of the underlying disease and graft-versus-host disease accounted for 17 % and 13 % of deaths, respectively.

The present analysis indicates unfavorable long-term outcomes for allogeneic stem cell recipients admitted to the ICU during the peri-transplant period. The need for organ failure support using MV and RRT displays the major risk factor for impaired survival. These results might offer advantages regarding informed decision making with patients and their families. 

J. Garcia Borrega, J.-M. Heger, P. Köhler, U. Holtick, M. Hallek, C. Scheid, M. Kochanek, B. Böll, A. Shimabukuro-Vornhagen, D. Eichenauer Klinik für Innere Medizin I, Universitätsklinikum Köln, Köln;

Objective: The overall prognosis of allogeneic stem cell recipients admitted to the intensive care unit ( ICU) has improved over the last decades. However, analyses focusing on patients treated on the ICU during the peritransplant period are scarce. We therefore conducted a retrospective study comprising 70 patients who underwent allogeneic stem cell transplantation (aSCT) at our institution between 2014 and 2020 and were admitted to the ICU during conditioning therapy or within 30 days from transplantation. Method: Between 2014 and 2020, 638 patients underwent aSCT at our institution. Among those, 70 individuals (11 %) were admitted to the ICU between the start of conditioning therapy and day 30 after aSCT and were thus eligible for the present analysis. Patient characteristics were extract- 

Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS

In der Cox-Regressionsanalyse zeigte sich das Auftreten einer schweren Leberfunktionsstörung als unabhängiger Prädiktor für Mortalität

Zusammenfassung: Bei COVID-19 ist eine schwere Leberfunktionsstörung relativ häufig, das Auftreten ist mit der Präsenz von Virämie und der Schwere der Erkrankung vergesellschaftet

(p < 0.001). After 24 h all differences were reduced by half and after 48-72 h Hgb and Hct values returned to baseline. Conclusion: Our research has led to significant improvements in the practice of DP: 1) Saline should be infused at DP as clinically indicated in agreement with the donor. 2) Young, female first-time donors require special care. 3) Due to the crossover design of the two trials with saline, the impact or level of evidence is high (estimated 1b).

Vorhersagewert des Renal Resistive Index in der unmittelbaren postoperativen Phase nach Nierentransplantation auf kurz-und langfristige Ergebnisse: ein Update S. Bogaert 

D. Jarczak, K. Roedl, M. Fischer, O. Boenisch, G. de Heer, D. Frings, B. Sensen, M. Karakas, S. Kluge, A. Nierhaus Klinik für Intensivmedizin, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg;Hintergrund: Die Coronaviruserkrankung 2019 ( COVID-19) führte zu einer großen Zahl kritisch kranker Patienten, die auf einer Intensivstation ( ICU) behandelt wurden. Etwa 20 % dieser Patienten benötigten eine Nierenersatztherapie. Aktuell ist unklar, welche Marker oder Charakteristika ein akutes Nierenversagen ( ANV) bzw. die Notwendigkeit einer Nierenersatztherapie valide vorhersagen können. Hier könnten neue Biomarker, wie mid-regional pro-adrenomedullin ( MR-proADM) durch ihre Beteiligung bei der Entwicklung eines Multiorganversagens eine Rolle spielen. Ziel dieser Studie war die Untersuchung, ob MR-proADM die Notwendigkeit einer Nierenersatztherapie bei kritisch kranken Patienten mit COVID-19 vorhersagen kann. Methode: Wir untersuchten alle Patienten mit bestätigter COVID-19 Erkrankung, die konsekutiv auf einer der 12 ICUs einer deutschen Universitätsklinik im Zeitraum März bis September 2020 behandelt wurden. Es wurden klinische Charakteristika und Daten zum Vorkommen eines ANV, der Nierenersatztherapie und zum Überleben erhoben. MR-proADM wurde im Rahmen der klinischen Routine bei Aufnahme gemessen. compared to Non-COVID-19 patients (19.1 % vs. 12.7 %, respectively; p = 0.04). These metabolic disarrangements were resistant to per-protocol adjustments and disappeared after replacement of the CRRT-filter. Conclusion: In contrast to initial concerns, adequate filter life-span can be achieved with RCA during CRRT in COVID-19 patients. However, close monitoring of the acid-base balance appears warranted, as these patients tend to develop reduced filter patency leading to a higher incidence of citrate overload and metabolic disturbances.

Impact of saline infusion during acute hypotensive events at donor plasmapheresis J. Evers, U. Taborski 1 Würselen; 1 Octapharma Plasma GmbH, AachenObjective: The purpose of our research was to evaluate the effects of saline infusion to counteract incidents of acute hypotension during donor plasmapheresis ( DP), and on immunoglobulin G ( IgG) content in collected plasma, and on donor hemoglobin (Hgb) and hematocrit (Hct) values. Method: IIt is based on three studies: an observation of saline infusion in donors with severe drops in blood pressure at DP, and two crossover trials of 32 repeat plasma donors each on saline 500 ml infusion during DP. DP was performed with the automated plasma collecting system ( PCS®2, Haemonetics) via a single needle technique. It operates in a discontinuous flow manner with 4-5 repetitive cycles of draw and collection phases alternating with return phases. Tri-sodium citrate 4 % ( TSC) is added in the withdrawal phase in a low flow ratio of 1: 16 to blood at the inlet line to the tubing set prior to the apheresis centrifuge. Separation of the plasma takes place in a disposable bowl by centrifugation at 6000 rpm. Most of TSC is retained in the separated plasma, the rest is re-infused to the donor. Note that extracorporeal volume increases during DP to the plasma already collected up to 800-1100 ml including AC at its maximum before the return phase of the last cycle. Results: We observed 50 cases with a significant acute drop of mean systolic blood pressure by 45 ± 16 mm HG in one year (incidence 0.15 %), predominantly in young, female first-time donors. After treatment with placing the donor in the Trendelenburg position along with rapid infusion of 1000 ml saline 49 ± 18 min after the event all plasma donors could safely leave the center. In trial 1, there was a reduction of IgG concentration in collected plasma related to the average IgG serum concentration without saline to 85.5 % vs. to 80.5 % with saline (p < 0.001). In trial 2, there was an important 11-12 % increase of the donor hematological values without saline during DP. The difference between the two samples without saline and with saline after the end of DP at 1 h of ±5.3 % was highly significant P45 Akut-auf-chronisches Leberversagen verändert nicht die Pharmakokinetik bei kritisch kranken Patienten mit kontinuierlichem Nierenersatzverfahren: eine prospektive Beobachtungsstudie J. Grensemann 

K. Roedl, D. Jarczak, A. Drolz 1 , D. Wichmann, G. de Heer, C. Burdelski, A. Nierhaus, M. Lütgehetmann 2 Fig. 1 | P46 8