CBP在ICU危重病中应用.pptVIP

* Hemodiafiltration (HDF) is the most aggressive of the CRRT therapies. Hemodiafiltration is described as…. Read first bullet point. Hemodiafiltration incorporates the…. Read the second bullet point. We will see how utilizing all fluid paths available within the system will increase effectiveness of the treatment and allow us to control fluid and electrolyte balance based on individual patient needs. * Describe flow paths on slide. Note: Point out again that … Replacement fluids may be administered either pre or post filter. We will discuss these options later in the program. * CVVHDF-Continuous Veno-Venous Hemodiafiltration is the therapy that will combine the benefits of CVVH and CVVHD using both convective and diffusive transport mechanisms to treat any number of acute problems. Review slide. Replacement and Dialysate fluids are both employed. A recent article (Palevsky et al) stated that any combination of replacement and dialysate fluids totaling 4.5 L/hr was adequate to control catabolic patients. * This slide illustrates the process of ultrafiltration. We now have two cups of fluid. Each cup contains two compartments separated by a semipermeable membrane. The cup on the left illustrates how the exertion of a positive pressure on the left compartment will PUSH fluid from that compartment to the one on the right. Similarly, looking at the cup on the right side of the slide, a negative pressure applied to the right compartment will PULL fluid from the compartment on the left into that on the right. How does this work in continuous therapies? * This schematic represents a hemofilter (hemodialyzer). Note that there is a semipermeable membrane separating the blood and fluid compartments. Blood exerts a positive pressure on the membrane as it passes from the patient, through the filter, and returns back to the patient. On the fluid side of the filter, a low pressure exists. It is the combination of these positive and negative pressures that tog