Advanced search
1 file | 589.48 KB Add to list

Expert statements on the standard of care in critically ill adult patients with atypical hemolytic uremic syndrome

(2017) CHEST. 152(2). p.424-434
Author
Organization
Abstract
A typical hemolytic uremic syndrome (aHUS) presents similarly to thrombotic thrombocytopenic purpura (TTP) and other causes or conditions with thrombotic microangiopathy (TMA), such as disseminated intravascular coagulation or sepsis. Similarity in clinical presentation may hinder diagnosis and optimal treatment selection in the urgent setting in the ICU. However, there is currently no consensus on the diagnosis or treatment of aHUS for ICU specialists. This review aims to summarize available data on the diagnosis and treatment strategies of aHUS in the ICU to enhance the understanding of aHUS diagnosis and outcomes in patients managed in the ICU. To this end, a review of the recent literature (January 2009-March 2016) was performed to select the most relevant articles for ICU physicians. Based on the paucity of adult aHUS cases overall and within the ICU, no specific recommendations could be formally graded for the critical care setting. However, we recognize a core set of skills required by intensivists for diagnosing and managing patients with aHUS: recognizing thrombotic microangiopathies, differentiating aHUS from related conditions, recognizing involvement of other organ systems, understanding the pathophysiology of aHUS, knowing the diagnostic workup and relevant outcomes in critically ill patients with aHUS, and knowing the standard of care for patients with aHUS based on available data and guidelines. In conclusion, managing critically ill patients with aHUS requires basic skills that, in the absence of sufficient data from patients treated within the ICU, can be gleaned from an increasingly relevant literature outside the ICU. More data on critically ill patients with aHUS are needed to validate these conclusions within the ICU setting.
Keywords
atypical hemolytic uremic syndrome, eculizumab, intensive care, organ failure, plasma exchange, thrombocytopenia, thrombotic microangiopathy, THROMBOTIC THROMBOCYTOPENIC PURPURA, COMPLEMENT INHIBITOR ECULIZUMAB, CONSENSUS DOCUMENT, SYNDROME DIAGNOSIS, I TREAT, MICROANGIOPATHIES, AHUS, UPDATE, ACTIVATION, MANAGEMENT

Downloads

  • 1-s2.0-S0012369217307353-main.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 589.48 KB

Citation

Please use this url to cite or link to this publication:

MLA
Azoulay, Elie, Paul Knoebl, José Garnacho-Montero, et al. “Expert Statements on the Standard of Care in Critically Ill Adult Patients with Atypical Hemolytic Uremic Syndrome.” CHEST 152.2 (2017): 424–434. Print.
APA
Azoulay, Elie, Knoebl, P., Garnacho-Montero, J., Rusinova, K., Galstian, G., Eggimann, P., Abroug, F., et al. (2017). Expert statements on the standard of care in critically ill adult patients with atypical hemolytic uremic syndrome. CHEST, 152(2), 424–434.
Chicago author-date
Azoulay, Elie, Paul Knoebl, José Garnacho-Montero, Katerina Rusinova, Gennadii Galstian, Philippe Eggimann, Fekri Abroug, et al. 2017. “Expert Statements on the Standard of Care in Critically Ill Adult Patients with Atypical Hemolytic Uremic Syndrome.” Chest 152 (2): 424–434.
Chicago author-date (all authors)
Azoulay, Elie, Paul Knoebl, José Garnacho-Montero, Katerina Rusinova, Gennadii Galstian, Philippe Eggimann, Fekri Abroug, Dominique Benoit, Michael von Bergwelt-Baildon, Julia Wendon, and Marie Scully. 2017. “Expert Statements on the Standard of Care in Critically Ill Adult Patients with Atypical Hemolytic Uremic Syndrome.” Chest 152 (2): 424–434.
Vancouver
1.
Azoulay E, Knoebl P, Garnacho-Montero J, Rusinova K, Galstian G, Eggimann P, et al. Expert statements on the standard of care in critically ill adult patients with atypical hemolytic uremic syndrome. CHEST. 2017;152(2):424–34.
IEEE
[1]
E. Azoulay et al., “Expert statements on the standard of care in critically ill adult patients with atypical hemolytic uremic syndrome,” CHEST, vol. 152, no. 2, pp. 424–434, 2017.
@article{8551926,
  abstract     = {A typical hemolytic uremic syndrome (aHUS) presents similarly to thrombotic thrombocytopenic purpura (TTP) and other causes or conditions with thrombotic microangiopathy (TMA), such as disseminated intravascular coagulation or sepsis. Similarity in clinical presentation may hinder diagnosis and optimal treatment selection in the urgent setting in the ICU. However, there is currently no consensus on the diagnosis or treatment of aHUS for ICU specialists. This review aims to summarize available data on the diagnosis and treatment strategies of aHUS in the ICU to enhance the understanding of aHUS diagnosis and outcomes in patients managed in the ICU. To this end, a review of the recent literature (January 2009-March 2016) was performed to select the most relevant articles for ICU physicians. Based on the paucity of adult aHUS cases overall and within the ICU, no specific recommendations could be formally graded for the critical care setting. However, we recognize a core set of skills required by intensivists for diagnosing and managing patients with aHUS: recognizing thrombotic microangiopathies, differentiating aHUS from related conditions, recognizing involvement of other organ systems, understanding the pathophysiology of aHUS, knowing the diagnostic workup and relevant outcomes in critically ill patients with aHUS, and knowing the standard of care for patients with aHUS based on available data and guidelines. In conclusion, managing critically ill patients with aHUS requires basic skills that, in the absence of sufficient data from patients treated within the ICU, can be gleaned from an increasingly relevant literature outside the ICU. More data on critically ill patients with aHUS are needed to validate these conclusions within the ICU setting.},
  author       = {Azoulay, Elie and Knoebl, Paul and Garnacho-Montero, José and Rusinova, Katerina and Galstian, Gennadii and Eggimann, Philippe and Abroug, Fekri and Benoit, Dominique and von Bergwelt-Baildon, Michael and Wendon, Julia and Scully, Marie},
  issn         = {0012-3692},
  journal      = {CHEST},
  keywords     = {atypical hemolytic uremic syndrome,eculizumab,intensive care,organ failure,plasma exchange,thrombocytopenia,thrombotic microangiopathy,THROMBOTIC THROMBOCYTOPENIC PURPURA,COMPLEMENT INHIBITOR ECULIZUMAB,CONSENSUS DOCUMENT,SYNDROME DIAGNOSIS,I TREAT,MICROANGIOPATHIES,AHUS,UPDATE,ACTIVATION,MANAGEMENT},
  language     = {eng},
  number       = {2},
  pages        = {424--434},
  title        = {Expert statements on the standard of care in critically ill adult patients with atypical hemolytic uremic syndrome},
  url          = {http://dx.doi.org/10.1016/j.chest.2017.03.055},
  volume       = {152},
  year         = {2017},
}

Altmetric
View in Altmetric
Web of Science
Times cited: