(精编)【持续性肾脏替代治疗CRRT英文精品课件】Acute Kidney Injury(91p).pptVIP

IHD Vs CRRT IHD Common mode of treatment of ARF Questions IHD Vs CRRT Daily or every other day Precautions: Patients with cardiovascular instability CRRT Dose High Vs Low clearance CRRT Dose: High Vs Low clearance  VA NIH ARF trail network, NEJM, V 359, no 1, July 2008. IHD Dose Daily Vs Alternate day IHD Schiffl H, N Engl J Med 2002;346:305-310 Daily Vs Alternate day IHD Schiffl H, N Engl J Med 2002;346:305-310 Timing of Dialysis Timing of Initiation of Dialysis Chertow et al, CJASN, 07 Summary of CRRT Type of RRT: CRRT in critically ill and hemodynamically unstable patients Initiation of RRT: Earlier the better Dose and quality: More better and convection clearance For non renal causes : Should be considered, ex. Toxins Special cases: Patients with sepsis, MODS or multiple trauma, role of RRT is to support rather than replace renal function Advantages of CRRT Suitable for use in hemodynamically unstable patients Precise volume control Very effective control of uremia Nurses with minimal training can take care of it Safer in patients with brain injuries and cardiovascular disorders. Probable advantages in terms of renal recovery Disadvantages of CRRT Expensive compared to IHD Anticoagulation – to prevent extra corporeal circuit from Clotting Complications of line insertion and sepsis. Prevention of AKI Prevention of Contrast induced AKI For studies where iodinated contrast material is used (for CT scan, angiography). Hydration is main mode of treatment: Isotonic Na bicarbonate: A bolus of 3 mL/kg for one hour prior to the procedure and continued at a rate of 1 mL/kg/hour for six hours after the procedure. (Add 150 mEq of Na bicarbonate to 850 ml of D5W to prepare Na bicarbonate solution. Or Isotonic saline: At a rate of 1 mL/kg/hour, begun 12 hours prior to the p