ARFCRRT台大概要1.ppt

Acute renal failure and CRRT in the ICU 台大醫院外科部護理師 蔡壁如 Introduction of Acute Renal Failure 17 ~ 25 % of ICU case develop ARF 5 ~ 10% of cases will require CRRT Outcome is dependent upon the original cause of ARF Mortality from underlying disease, and complication like sepsis Medical chart review Evaluation of prerenal ARF -- Intravascular volume status -- Urinary volume ? -- Serum electrolyte offers valuable information Evaluation of renal ARF: -- GFR ?, due to Kidney injury Evaluation of renal ARF: -- Obstruction of urinary tract The cause of ARF Medical chart review Clinical Feature: ? Evidence of intravascular volume depletion: Weight ?, Flat neck vein, hypotension ? Fluid overload: Edema, pulmonary rales, congestive hear failure ?Exposure to renal insults associated with ATN Hypotension. Surgery transfusion reaction, dye exposure ? Uninary obstruction Anuria, large swings in urine flow rate Medical chart review Diagnosis of ARF: -- Nitrogenous-based waste products ? 1. Serum Cre. ? 0.5 mg/dL 2. Baseline serum Cre. Level ?50% or more 3. Ccr ? 25% -- GFR: rapid reduction Acute Renal Failure Defined Creatinine ? 3.5 mg/dL BUN ? 100mg/dL, or 36 mmol/L or Concentration is 100% above the baseline valve in p’t with chronic renal insufficiency ( Creatinine ? 1.8 mg/dL ) Exclude : Creatinine ? 3.4 mg/dL Criteria for identification of patients with acute renal failure(ARF) Proposed classification of acute renal dysfunction RIFLE Risk Injury Function Loss End stage “Susceptibility” and “ Insult”? outcome “Response” and “end-organ” ? Severity S2-I3 and R3-E1 or R2-E?2 ? Intervention Medical chart review about Pre-renal ARF Hospital-acquired ARF: -- Due to effective renal perfusion? Ex: Congestive heart failure, liver cirrhosis, sepsis, Massive bleeding Pre-renal ARF? ischemic ATN -- Reverse the cause of ARF: Necessary FENa = Una / Pna x PCr / Uc