心脏外科术后急性肾衰患者连续性血液净化治疗的观察和护理

急性肾衰竭(ARF)是心脏术后多器官功能障碍综合征(MODS)死亡原因中最常见和最主要的因素.由于心脏术后早期动力学尚不稳定,绝大多数并发ARF的患者不能耐受传统的间隙性血液透析(IHD)治疗.1997年Kramer等[1]首先将连续性动静脉血液滤过(CAVH)应用于临床.此后在CAVH的基础上又衍生出多种方式连续性血液净化技术,目前将这一类技术称为连续性肾脏替代治疗(CRRT).南京医科大学第一附属医院血液净化中心2003年2月～2006年6月采用连续性血液净化技术中的一种连续性静脉-静脉血液透析滤过(CVVHDF)用于救治35例心脏术后并发MODS患者,现将护理体会报道如下.……     

关于“连续性肾脏替代疗法”命名的探讨

连续性肾脏替代疗法(continuousrenalreplacementtherapy,CRRT)是由Scribner等人在1960年提出的,主要解释为缓慢的、连续清除水和溶质的一种治疗方式。现有的动静脉缓慢连续超滤(AVSCUF)、连续性动静脉血液滤过(CAVH)、连续性动静脉血液透析滤过(CAVHDF)、连续性动静脉血液透析(CAVHD)、静静脉缓慢连续超滤(VVSCUF)、连续性静静脉血液滤过(CVVH)、连续性静静脉血液透析滤过(CVVHDF)、连续性静静脉血液透析(CVVHD)都属于此范畴。CRRT中的“replacement”英语一词,可译成替代、取代、代替,实际上替代是一种代替。虽然,近…     

连续性静静脉血液滤过在危重症患者中的应用研究

1977年Kramer等首先提出了连续性动静脉血液滤过技术并应用于临床。经过30年的临床实践，人们将上述由连续性动静脉血液滤过（CAVH）派生出的一系列治疗模式统称为连续性。肾脏替代治疗（continuous renal replacement therapy，CRRT）。     

使用连续性肾替代治疗床边机ADM08TM/ABMTM治疗重症急性肾功能衰竭

1977年Kramer等首次将连续性动静脉血液滤过(CAVH)应用于临床,经过20余年反复摸索与实践,在此基础上发展起来的连续性肾替代治疗(CRRT)技术已日趋成熟。CRRT作为一种新技术,在抢救重症急性肾功能衰竭(SARF)、多脏器功能障碍综合征(MODS)等疾病中已经显现出其独特的优势。我院于1999年初在国内率先引进德国FreseniusADM08TM/ABMTM床边机开展连续性静静脉血液滤过(CVVH)治疗SARF,目前已治疗患者13例68例次,取得较好临床疗效。1　对象与方法1.1　病例选择:13例为1999年3月～2000年5月住我院中心ICU的SARF患者,其中男8例,女5…     

血液吸附技术在危重症患者中的应用

<正>随着生物材料的不断发展和血液净化设备的不断改进,血液净化技术正飞速发展,更加多样化,在临床上应用也越来越广泛[1]。1982年美国FDA批准连续动静脉血液滤过(CAVH)可在重症监护病房(ICU)应用,从而相继衍生出更多血液净化方式,并应用于非肾脏病领域。1998年Tetta等[2]提出连续性血浆滤过吸附(CPFA),该研究表明连续性血浆滤过吸附通过增加对炎性介质和细胞因子的清除率,调整内环境平     

连续性肾脏替代治疗45例临床护理

目的:探讨连续性肾脏替代治疗(CRRT)在肾脏病领域和其他重症疾病中的应用及护理方法。方法:对45例患者应用CRRT技术,采用连续性静脉-静脉血液滤过(CVVH)的方法进行抢救。结果:45例患者在CRRT治疗期间生命体征平稳,所有患者均能较好地维持水、电解质及酸碱平衡。结论:CRRT技术是抢救肾脏病及其他重症疾病的重要治疗手段。     

血液净化从肾脏替代向多器官功能支持的演变

血液透析和透析膜的发展已经跨越近一个世纪的时空。1977年Kramer等在血液透析的理论和实践基础上提出连续动静脉血液滤过(CAVH)并应用于临床,1982年美国FDA批准CAVH在ICU中应用。1992年,Grootendorst首次建立内毒素引起猪休克模淹,证实高容量血液滤过(HVHF)可以减少脓毒症休克     

PRISMA系统行连续性肾脏替代治疗的护理体会

连续性动脉静脉血液滤过(CAVH)是模拟正常肾小球的滤过功能,将血液引入一个小型、高效能、低阻力的滤过器,使得血液中的水分不断被超滤,同时补充置换液,借以清除体内多余的水份及氮质产物,维持酸碱平衡的操作过程.CAVH自1975年应用于临床,前景至今不衰,为急性肾功能衰竭尤其是合并多器官功能障碍(MODS)的救治带来光明的前景,其模式已由经典的CAVH衍生出泵驱动式的连续性静脉-静脉血液滤过(CVVH),连续性动脉-静脉血液透析(CAVHD),连续性静脉-静脉血液透析滤过(CVVHDF)等多种形式,称之为连续性肾脏替代治疗(CRRT),是应用于重症急性肾功能衰竭合并多器官功能衰竭的最安全、有效的治疗手段.这些手工操作过程虽然逐渐改革为常规化、便捷化、轻松化的工作,仍带有操作者的主观性,不能精确维持水平衡,需耗费大量的人力、物力.从1998年6月到2001年12月我院用HOSPAL公司的全自动PRISMA系统治疗了32例急性肾功能衰竭合并多器官功能障碍的患者,减少了上述缺陷,取得满意的疗效,报告如下.     

36例手术后急性肾功能衰竭患者CRRT应用研究

连续性肾脏替代干预（CRRT）是指所有缓慢、连续清除水和溶质的干预方式。1977年,Kramer等首次将连续性动静脉血液滤过（CAVH）应用于临床,CRRT干预具有稳定的血流动力学,能较平缓地清除液体、清除炎症介质、以及补充大量的营养成分;持续有效地控制氮质血症及电解质水盐代谢,     

危重患者连续性肾脏替代治疗时抗生素剂量的调整

重症监护病房(ICU)中大约有5%的患者需要血液净化治疗[1].在过去的几十年里,危重患者的血液净化技术得到了快速的发展[2],连续性肾脏替代治疗(CRRT)已经成为危重患者主要的血液净化治疗模式[3-5].     

Continuous renal replacement therapy: dialytic therapy for acute renal failure in intensive care.

Acute renal failure (ARF) is a common complication of critically ill patients in today's intensive care units. Intermittent renal replacement therapy for these types of patients may be limited or ineffective due to the critical nature of their illness. Volume overload and hemodynamic instability are complications that may not be treated adequately with conventional forms of dialysis, such as hemodialysis or peritoneal dialysis. Continuous renal replacement therapy (CRRT) is rapidly gaining ground as the treatment of choice for ARF in the intensive care unit (ICU) due to its slow, gentle nature of water and solute removal Critical care nurses are responsible for monitoring this therapy, but a collaborative effort with nephrology nurses' expertise and background in dialysis therapies is a key ingredient in implementation of a successful CRRT program. This article will review the causes of ARF, the history of CRRT, current treatment options, trends, and implementation of a successful CRRT program.     

Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy

Purpose  

In pediatric intensive care unit (PICU) patients, fluid overload (FO) at initiation of continuous renal replacement therapy (CRRT) has been reported to be an independent risk factor for mortality. Previous studies have calculated FO based on daily fluid balance during ICU admission, which is labor intensive and error prone. We hypothesized that a weight-based definition of FO at CRRT initiation would correlate with the fluid balance method and prove predictive of outcome.     

Clinical review: Optimal dose of continuous renal replacement therapy in acute kidney injury

Continuous renal replacement therapy (CRRT) is the preferred treatment for acute kidney injury in intensive care units (ICUs) throughout much of the world. Despite the widespread use of CRRT, controversy and center-specific practice variation in the clinical application of CRRT continue. In particular, whereas two single-center studies have suggested survival benefit from delivery of higher-intensity CRRT to patients with acute kidney injury in the ICU, other studies have been inconsistent in their results. Now, however, two large multi-center randomized controlled trials - the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) study and the Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement Therapy Study - have provided level 1 evidence that effluent flow rates above 25 mL/kg per hour do not improve outcomes in patients in the ICU. In this review, we discuss the concept of dose of CRRT, its relationship with clinical outcomes, and what target optimal dose of CRRT should be pursued in light of the high-quality evidence now available.     

Comparison of circuit patency and exchange rates between 2 different continuous renal replacement therapy machines

Background

Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration–approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines.

Materials and Methods

A group of ICU nurses were selected to undergo expanded training in CRRT operation and empowered to deliver all aspects of CRRT. The ICU nurses then provided all aspects of CRRT on 2 Food and Drug Administration–approved CRRT devices for 6 months. Each device was used exclusively in the designated ICU for a 2-week run-in period followed by 3-month data collection period. The primary end point for the study was the differences in average number of filter exchanges per day during each CRRT event.

Results

A total of 45 unique patients who underwent 64 separate CRRT treatment periods were included. Four CRRT events were excluded (see text for details). Twenty-eight CRRT events occurred in the NxStage System One arm (NxStage Medical, Lawrence, Mass) and 32 events in the Gambro Prismaflex arm (Gambro Renal Products, Boulder, Colo). Average (SD) filter exchanges per day was 0.443 (0.60) for the NxStage System One machine and 0.553 (0.65) for Gambro Prismaflex machine (P = .09).

Conclusions

There was no demonstrable difference in circuit patency as defined by the rate of filter exchanges per day of CRRT therapy.     

Continuous haemofiltration in the intensive care unit

Continuous renal replacement therapy (CRRT) was first described in 1977 for the treatment of diuretic-unresponsive fluid overload in the intensive care unit (ICU). Since that time this treatment has undergone a remarkable technical and conceptual evolution. It is now available in most tertiary ICUs around the world and has almost completely replaced intermittent haemodialysis (IHD) in some countries. Specially made machines are now available, and venovenous therapies that use blood pumps have replaced simpler techniques. Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior. The use of CRRT has also spurred renewed interest in the broader concept of blood purification, particularly in septic states. Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients. The evolution and use of CRRT is likely to continue and grow over the next decade.     

Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study

Introduction  

Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU).     

Practical considerations for the dosing and adjustment of continuous renal replacement therapy in the intensive care unit

Familiarity with the initiation, dosing, adjustment, and termination of continuous renal replacement therapy (CRRT) is a core skill for contemporary intensivists. Guidelines for how to administer CRRT in the intensive care unit are not well documented. The purpose of this review is to discuss the modalities, terminology, and components of CRRT, with an emphasis on the practical aspects of dosing, adjustments, and termination. Management of electrolyte and acid-base derangements commonly encountered with acute renal failure is emphasized. Knowledge regarding the practical aspects of managing CRRT in the intensive care unit is a prerequisite for achieving desired physiological end points.     

Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery

OBJECTIVE: Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choosing the method of dialysis. As such, the objective of this study was to estimate the cost of CRRT and intermittent hemodialysis in the intensive care unit and to explore the impact of renal recovery on subsequent clinical outcomes and costs among survivors. DESIGN: Retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996, and March 31, 1999. SETTING: Two tertiary care intensive care units in Calgary, Canada. PATIENTS: A total of 261 critically ill patients. INTERVENTIONS: None. MEASUREMENTS: All patients were followed to determine in-hospital and subsequent clinical outcomes (survival and frequency of renal recovery). The immediate and potential long-term costs of CRRT and intermittent hemodialysis were measured. MAIN RESULTS: The cost of performing CRRT ranged from Can 3,486 dollars to Can 5,117 dollars per week, depending on the modality and the anticoagulant used, and it was significantly more expensive than intermittent hemodialysis (Can 1,342 dollars per week). Survivors with renal recovery spent significantly fewer days in hospital (11.3 vs. 22.5 days, p<.001) and incurred less healthcare costs (11,192 dollars vs. 73,273 dollars, p<.001) over the year after hospital discharge compared with survivors who remained on dialysis. CONCLUSIONS: Immediate cost savings could be achieved by increasing the use of intermittent hemodialysis rather than CRRT for patients with acute renal failure in the intensive care unit. Because of the high cost of ongoing dialysis, CRRT may still be an economically efficient treatment if it improves renal recovery among survivors; further study in this area is required.     

Critical care nursing and continuous renal replacement techniques in the Madrid Community

The continuous renal replacement techniques (CRRT) aim to substitute the altered renal function during a period of time, presenting advantages compared to conventional hemodialysis (CH). This study aims to determine the situation of the CRRT in the Intensive care units (ICU) of the Madrid Community (MC) using a survey distributed to nurses (n = 131) of 14 ICU. It evaluates four aspects of the CRRT: management model, knowledge, problems and degree of satisfaction. It identified four models, the most frequent is that in which ICU nurse and intensivist participate (60%). Self-evaluation of knowledge was fair in 55.7% of the cases and the mean of correct responses in an evaluation of 10 questions was 4.19 and 5.45 in those with previous courses. A total of 84.7% think that CRRT significantly increases the workloads and 62.6% believe that they should be done by the ICU nurses. The main problem is the lack of knowledge to resolve complications during the technique. We conclude that the ICU nursing can handle the CRRT, adapting the nurse/patient ratio; training programs should be established and the role of the teaching nurse defined in critical renal cares.     

Predicting successful continuous renal replacement therapy liberation in critically ill patients with acute kidney injury

PurposeNo standardized criteria for continuous renal replacement therapy (CRRT) liberation have been established. We sought to develop and internally validate prediction models for successful CRRT liberation in critically ill patients with acute kidney injury (AKI).Materials and methodsThis single-center, retrospective cohort study included adult patients admitted to intensive care units (ICUs) with AKI and treated with CRRT from January 1, 2007, to May 4, 2018, at a tertiary referral hospital. The cohort was randomly divided into derivation and validation sets. The outcomes were successful CRRT liberation, defined as renal replacement therapy (RRT)-free survival within 72 h after the liberation and hospital discharge. Multivariate logistic regression models were developed and internally validated.ResultsOf 1135 AKI patients requiring CRRT, successful CRRT liberation and RRT-free survival at hospital discharge were observed in 228 (20%) and 395 (35%) individuals, respectively. The independent predictors included mean hourly urine output within 12 h before liberation, mean serum creatinine value within 24 h before liberation, cumulative fluid balance from ICU admission to liberation, CRRT duration before liberation, and the requirement of vasoactive agents within 24 h before liberation. The models demonstrated good discrimination (AUROC, 0.76 and 0.78; positive predictive value, 36% and 48%; negative predictive value, 92% and 94%; respectively) and calibration in the validation set.ConclusionsThese validated models could assist the decision-making related to the CRRT liberation in critically ill patients with AKI.