Universität zu Köln

Azoulay, Elie, Knoebl, Paul ORCID: 0000-0002-7909-7225, Garnacho-Montero, Jose ORCID: 0000-0003-2542-7601, Rusinova, Katerina, Galstian, Gennadii, Eggimann, Philippe, Abroug, Fekri, Benoit, Dominique, von Bergwelt-Baildon, Michael, Wendon, Julia and Scully, Marie (2017). Expert Statements on the Standard of Care in Critically Ill Adult Patients With Atypical Hemolytic Uremic Syndrome. Chest, 152 (2). S. 424 - 435. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 0012-3692

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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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Azoulay, Elie UNSPECIFIED UNSPECIFIED UNSPECIFIED Knoebl, Paul UNSPECIFIED orcid.org/0000-0002-7909-7225 UNSPECIFIED Garnacho-Montero, Jose UNSPECIFIED orcid.org/0000-0003-2542-7601 UNSPECIFIED Rusinova, Katerina UNSPECIFIED UNSPECIFIED UNSPECIFIED Galstian, Gennadii UNSPECIFIED UNSPECIFIED UNSPECIFIED Eggimann, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Abroug, Fekri UNSPECIFIED UNSPECIFIED UNSPECIFIED Benoit, Dominique UNSPECIFIED UNSPECIFIED UNSPECIFIED von Bergwelt-Baildon, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Wendon, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Scully, Marie UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-223655
DOI:	10.1016/j.chest.2017.03.055
Journal or Publication Title:	Chest
Volume:	152
Number:	2
Page Range:	S. 424 - 435
Date:	2017
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	0012-3692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language THROMBOTIC THROMBOCYTOPENIC PURPURA; COMPLEMENT INHIBITOR ECULIZUMAB; CONSENSUS DOCUMENT; SYNDROME DIAGNOSIS; I TREAT; MICROANGIOPATHIES; AHUS; UPDATE; ACTIVATION; MANAGEMENT Multiple languages Critical Care Medicine; Respiratory System Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22365