(精编)【持续性肾脏替代治疗CRRT英文精品课件】CVVH-continuous veno-venous hemofiltration (65p).pptVIP

head trauma scenario III: questions Over 30 liters of ultrafiltrate is being produced per day; this child weighs only twenty kilograms. A replacement solution is infused to offset most of the volume lost. The following scenario can be imagined: at the onset of high flow CVVH, the child had a moderate metabolic acidosis (base deficit -3 mmol/L). After two days of high flow CVVH, hemodynamics are stable but the base deficit is -8 mmol/L. Is there a problem with the replacement solution? scenario IV Septic shock, day #5 of hospitalization. CVVH was initiated three days previously, and the body weight has been returned to baseline. Ultrafiltrate production is now continued at a rate of 1440 cc/hour, controlled by a flow regulator on the outflow port of the filter. dry weight:?????????20.0 kg todays weight:??? 20.5 kg bloodflow through filter:?? 75 cc / min ultrafiltrate production:??? 25 cc / min scenario IV No net deficit is desired. Fluids IN / OUT should be balanced. question: ultrafiltrate is produced at 1440 cc / hour. What limitations in equipment might prevent such a high rate of production? urea clearance Curea = UFR x 1.73 pt’s BSA Thus, in a child with body surface area = 1.0 m2, a Curea of about 15 ml/min/1.73 m2 is obtained when UFR = 8.7 ml/min or 520 ml/hr. This same clearance can be achieved in the 1.73 m2 adolescent with a UFR = 900 ml/hr. Curea: (ml/min/1.73 m2 BSA) urea clearance When target urea clearance (Curea) is set at 15 ml/min/1.73 m2, the equation can be solved for UFR: 15 = UFR x 1.73 / pt’s BSA UFR = 15 / 1.73 = 8.7 ml/min Curea: (ml/min/1.73 m2 BSA) Sluggishness A filtration rate of more than 25 - 30% greatly increases blood viscosity within the circuit, risking clot and malfunction. Oncotic pressure increases as Protein-free plasma is filtered, at one point the oncotic pressure will equalize the hydrostatic pressure and filtration will cease. Replacement Ultrafiltrate is concur