【持续性肾脏替代治疗CRRT英文ppt课件】血液净化CBP (91p).pptVIP

CRRTvsIHDCochrane2007.pdf Question 8 Define the different modes of CRRT. Use a diagram to highlight the differences? (Noemie) It is decided to start the patient on CRRT therapy. What kind of anticoagulation should he receive? Question 9 Compare the different modes of anticoagulation. Explain the use of citrate and how to dose it. Please explain the calcium gap. (Noemie) Anticoagulation Heparin Can be given systemically or through circuit Aim for PTT 35-45 sec Regional citrate Intensive Care Med 2004;30:260-265 Kidney International 2005;67:2361-2367 RIFLE Criteria The Acute Dialysis Quality Initiative Group proposed the RIFLE system classifying ARF into 3 severity groups and 2 clinical outcome categories CBP Nephrolology What is the incidence of AKI in the ICU and how does it affect patient outcomes? What are some traditional and novel methods for detecting acute kidney injury? Incidence of AKI in the ICU AKI occurs in ~ 7% of all hospitalized patients, whereas it occurs in 36% – 67% of critically ill patients. On average, 5 % of ICU patients with AKI require renal replacement therapy. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010 Jan;38(1):261-75 AKI and mortality In most studies, mortality rates rise proportionally with severity of AKI. Even small increases in serum creatinine have been associated with increasing mortality in various ICU populations despite adjusting for severity of illness and comorbidities. In patients with AKI requiring RRT, mortality rates reach 50% to 70%. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010 Jan;38(1):261-75 AKI and other outcomes AKI is also associated with: Increased length of stay Increased incidence of CKD and end-stage kidney disease Increased cost For example, an increase in SCr of 0.5 mg/dl (38 mmol/L)was as