试著将寡尿状态转成非寡尿状态此举虽不能治疗肾衰竭.ppt

Does Early Renal Replacement Therapy Improve the Clinical Outcome of Acute Renal Failure? Ri 許銘哲 2008/04/28 Background Diuretic therapy and early renal replacement therapy (RRT) are widely used in NTUH SICU. My Question Does early RRT improve the clinical outcome of acute renal failure? The Bible says… …試著將寡尿狀態轉成非寡尿狀態。此舉雖不能治療腎衰竭本身，但可方便臨床照護。… ~ 台大外科重症加護醫療手冊 Searching Strategy Cochrane Library Medline Key word: acute renal failure Clinical queries: therapy (optimized) Publication types: clinical trials, research support Medline Results The Other Question Does early RRT improve the clinical outcome of acute renal failure? Indication for RRT Elective Cr>8-12mg/dL, BUN>100-120mg/dL, Ccr<5 Emergent Uremic symptoms Refractory hyperkalemia (K>6.5meq/L) Refractory metabolic acidosis (pH<7.2) Fluid overload or lung edema, poor response to diuretics ~ 台大外科重症加護醫療手冊 In Fact… Cochrane Review Medline Results Search Results Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: A prospective, randomized trial Catherine S. C. Bouman, MD; Heleen M. Oudemans-van Straaten, MD, PhD. et al. Background Non-randomized studies (Gettings LG. et al. 1999) Earlier initiation of RRT and higher ultrafiltrate rates might improve survival and recovery of renal function. Prospective randomized study (Ronco C. et al. 2000) Increasing ultrafiltrate rate improve the survival. Goal To evaluate the effects of initiation time of hemofiltration and of ultrafiltrate rate in patients with circulatory and respiratory insufficiency and early ARF. Methods Randomized trial EHV (early high-volume hemofiltration) ELV (early low-volume hemofiltration) LLV (late low-volume hemofiltration) Two hospitals with closed-format multidisciplinary ICU, both practiced cardiosurgery Academic Medical Center (30 bed) Onze Lieve Vrouwe Gasthuis (18 bed) Inclusion Criteria Included if fulfills the criteria below…