Continuous Renal Replacement Therapy.ppt

Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, Inc. Gaithersburg, MD Definition of Terms SCUF - Slow Continuous Ultrafiltration CAVH - Continuous Arteriovenous Hemofiltration CAVH-D - Continuous Arteriovenous Hemofiltration with Dialysis CVVH - Continuous Venovenous Hemofiltration CVVH-D - Continuous Venovenous Hemofiltration with Dialysis Indications for Continuous Renal Replacement Therapy Remove excess fluid because of fluid overload Clinical need to administer fluid to someone who is oliguric Nutrition solution Antibiotics Vasoactive substances Blood products Other parenteral medications Advantages of ContinuousRenal Replacement Therapy Hemodynamic stability Avoid hypotension complicating hemodialysis Avoid swings in intravascular volume Easy to regulate fluid volume Volume removal is continuous Adjust fluid removal rate on an hourly basis Customize replacement solutions Lack of need of specialized support staff Disadvantages of ContinuousRenal Replacement Therapy Lack of rapid fluid and solute removal GFR equivalent of 5 - 20 ml/min Limited role in overdose setting Filter clotting Take down the entire system Basic Principles Blood passes down one side of a highly permeable membrane Water and solute pass across the membrane Solutes up to 20,000 daltons Drugs electrolytes Infuse replacement solution with physiologic concentrations of electrolytes Basic Principles Hemofiltration Convection based on a pressure gradient ‘Transmembrane pressure gradient’ Difference between plasma oncotic pressure and hydrostatic pressure Dialysis Diffusion based on a concentration gradient CVVHContinuous Veno-Venous Hemofiltration CVVHContinuous VV Hemofiltration Primary therapeutic goal: Convective solute removal Management of intravascular volume Blood Flow rate = 10 - 180 ml/min UF rate ranges 6 - 50 L/24 h ( 500 ml/h) Requires replacement solution to drive convection No dialysate CVVH Perfo