1
|
Zhu J, Qin H, Jin K, Hong Y, Wang M. Strategy analysis of bedside CRRT nursing in intensive care unit. Minerva Surg 2021; 77:412-414. [PMID: 34714031 DOI: 10.23736/s2724-5691.21.09217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jiashan Zhu
- Department of Emergency ICU, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China -
| | - Hanzhi Qin
- Department of Nursing, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| | - Kui Jin
- Department of Emergency ICU, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| | - Yan Hong
- Department of Emergency ICU, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| | - Meng Wang
- Department of Emergency ICU, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| |
Collapse
|
2
|
Zhang YL, Hu WP, Zhou LH, Wang Y, Cheng A, Shao SN, Hong LL, Chen QY. Continuous renal replacement therapy in children with multiple organ dysfunction syndrome: a case series. Int Braz J Urol 2015; 40:846-52. [PMID: 25615255 DOI: 10.1590/s1677-5538.ibju.2014.06.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/06/2014] [Indexed: 11/22/2022] Open
Abstract
There is a lack of definitive information regarding the precise indications, implementation, and outcomes of continuous renal replacement therapy (CRRT) for the treatment of critically ill children. Six children (three boys, three girls) aged from 3 days to 8 years, all of whom had multiple organ failure, were submitted to bedside CRRT using M60 filter membranes. Modified Port carbonate formula was used and clotting time was maintained between 20 and 30 minutes. Activated partial thromboplastin time was 1.5- to 2-fold normal. One patient discontinued treatment due to family decision. Marked improvements were seen in the remaining five patients, including normalization of blood urea nitrogen and creatinine levels, stabilization of electrolytes, and improvements in markers of organ function. Of note, one patient (a six-year-old male) underwent the treatment for 241 hours. All five patients were subsequently discharged and recovered uneventfully. CRRT is effective for the management of children who are critically ill due to multiple organ failure.
Collapse
Affiliation(s)
- Yan-lin Zhang
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Wei-ping Hu
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Ling-hui Zhou
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Yin Wang
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Ao Cheng
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Si-nan Shao
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Ling-Ling Hong
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Qiu-yue Chen
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen 361003, People's Republic of China and Department of Nephrology, The First Hospital of Xiamen, Fujian Medical University, Xiamen 361003, People's Republic of China
| |
Collapse
|
3
|
Clark E, Wald R, Levin A, Bouchard J, Adhikari NKJ, Hladunewich M, Richardson RMA, James MT, Walsh MW, House AA, Moist L, Stollery DE, Burns KEA, Friedrich JO, Barton J, Lafrance JP, Pannu N, Bagshaw SM. Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study. Can J Anaesth 2012; 59:861-70. [PMID: 22752716 DOI: 10.1007/s12630-012-9750-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The optimal timing for starting renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is unknown. Defining current practice is necessary to design interventional trials. We describe the current Canadian practice regarding the timing of RRT initiation for AKI. METHODS An observational study of patients undergoing RRT for AKI was undertaken at 11 intensive care units (ICUs) across Canada. Data were captured on demographics, clinical and laboratory findings, indications for RRT, and timing of RRT initiation. RESULTS Among 119 consecutive patients, the most common ICU admission diagnosis was sepsis/septic shock, occurring in 54%. At the time of RRT initiation, the median and interquartile range (IQR) serum creatinine level was 322 (221-432) μmol·L(-1). The mean (SD) values for other parameters were as follows: Sequential Organ Failure Assessment (SOFA) score 13.4 (4.1), pH 7.25 (0.15), potassium 4.6 (1.0) mmol·L(-1). Also, 64% fulfilled the serum creatinine-based criterion for Acute Kidney Injury Network (AKIN) stage 3. Severity of illness, measured using Acute Physiology and Chronic Health Evaluation (APACHE II) and SOFA scores, did not correlate with AKI severity as defined by the serum creatinine-based AKIN criteria. Median (IQR) time from hospital and ICU admission to the start of RRT was 2.0 (1.0-7.0) days and 1.0 (0-2.0) day, respectively. CONCLUSION Patients admitted to an ICU who were started on RRT generally had advanced AKI, high-grade illness severity, and multiorgan dysfunction. Also, they were started on RRT shortly after hospital presentation. We describe the current state of practice in Canada regarding the initiation of RRT for AKI in critically ill patients, which can inform the designs of future interventional trials.
Collapse
Affiliation(s)
- Edward Clark
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Clark E, Wald R, Walsh M, Bagshaw SM. Timing of initiation of renal replacement therapy for acute kidney injury: a survey of nephrologists and intensivists in Canada. Nephrol Dial Transplant 2011; 27:2761-7. [PMID: 22207332 DOI: 10.1093/ndt/gfr740] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about factors that influence the timing of initiation of renal replacement therapy (RRT) for acute kidney injury (AKI). We sought to better describe these factors for Canadian physicians that prescribe RRT for AKI. METHODS A web-based survey was conducted of physicians involved in the decision to initiate RRT for critically ill patients in Canada. Participants were asked about the factors that prompt them to initiate RRT for AKI both directly and using scenario-based questions. RESULTS Surveys completed by 180 physicians at 32 different sites were included for analysis. Serum potassium level and severity of pulmonary edema were the most commonly utilized factors for deciding when RRT should be started. For all clinical and laboratory factors inquired about, there was wide variation in the minimum severity that prompted respondents to indicate that they would initiate RRT. Additional factors that influenced the timing of initiation were the time-of-day that laboratory and clinical results became available, patient age and co-morbidity, responsiveness to a diuretic challenge and the specialty of the prescribing physician. Over 90% of respondents indicated that a randomized controlled trial to assess the optimal timing of initiation of RRT for AKI is ethically justified. CONCLUSIONS These results provide insight into clinical and laboratory factors that influence the timing of initiation of RRT for AKI and may aid in the design of future trials. While most clinicians consider the degree of hyperkalemia and pulmonary edema in deciding when to initiate RRT for AKI, there is a wide range of clinical practice, uncertainty regarding the optimal timing of initiation and enthusiasm for prospective interventional studies to address this topic.
Collapse
Affiliation(s)
- Edward Clark
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | | | | |
Collapse
|
5
|
Bagshaw SM, Bellomo R, Devarajan P, Johnson C, Karvellas CJ, Kutsiogiannis DJ, Mehta R, Pannu N, Romanovsky A, Sheinfeld G, Taylor S, Zappitelli M, Gibney RTN. Review article: Renal support in critical illness. Can J Anaesth 2010; 57:999-1013. [PMID: 20931311 DOI: 10.1007/s12630-010-9376-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 08/12/2010] [Indexed: 01/20/2023] Open
Abstract
PURPOSE This review provides a focused and comprehensive update on established and emerging evidence in acute renal replacement therapy (RRT) for critically ill patients with acute kidney injury (AKI). PRINCIPAL FINDINGS There have been considerable technological innovations in the methods and techniques for provision of extracorporeal RRT in critical illness. These have greatly expanded our capability to provide both renal and non-renal life-sustaining organ support for critically ill patients. Recent data suggest earlier initiation of RRT in AKI may confer an advantage for survival and renal recovery. Two large trials have recently shown no added benefit to augmented RRT dose delivery in AKI. Observational data have also suggested that fluid accumulation in critically ill patients with AKI is associated with worse clinical outcome. However, several fundamental clinical questions remain to be answered, including issues regarding the time to ideally initiate/discontinue RRT, the role of high-volume hemofiltration or other blood purification techniques in sepsis, and extracorporeal support for combined liver-kidney failure. Extracorporeal support with RRT in sepsis, rhabdomyolysis, and liver failure are discussed, along with strategies for drug dosing and management of RRT in sodium disorders. CONCLUSIONS We anticipate that this field will continue to expand to promote research and innovation, hopefully for the benefit of sick critically ill patients.
Collapse
Affiliation(s)
- Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:317. [PMID: 19909493 PMCID: PMC2811906 DOI: 10.1186/cc8037] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Critically ill patients whose course is complicated by acute kidney injury often receive renal replacement therapy (RRT). For these patients, initiation of RRT results in a considerable escalation in both the complexity and associated cost of care. While RRT is extensively used in clinical practice, there remains uncertainty about the ideal circumstances of when to initiate RRT and for what indications. The process of deciding when to initiate RRT in critically ill patients is complex and is influenced by numerous factors, including patient-specific and clinician-specific factors and those related to local organizational/logistical issues. Studies have shown marked variation between clinicians, and across institutions and countries. As a consequence, analysis of ideal circumstances under which to initiate RRT is challenging. Recognizing this limitation, we review the available data and propose a clinical algorithm to aid in the decision for RRT initiation in critically ill adult patients. The algorithm incorporates several patient-specific factors, based on evidence when available, that may decisively influence when to initiate RRT. The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in critically ill adult patients. In addition, the proposed algorithm is intended to provide a foundation for prospective evaluation and the development of a broad consensus on when to initiate RRT in critically ill patients.
Collapse
|
7
|
Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care 2009; 24:129-40. [DOI: 10.1016/j.jcrc.2007.12.017] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 10/06/2007] [Accepted: 12/15/2007] [Indexed: 01/20/2023]
|
8
|
Bagshaw SM, Gibney RTN. Ideal determinants for the initiation of renal replacement therapy: timing, metabolic threshold or fluid balance? Acta Clin Belg 2008; 62 Suppl 2:357-61. [PMID: 18283999 DOI: 10.1179/acb.2007.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with acute kidney injury (AKI) frequently require initiation of renal replacement therapy (RRT). Currently there is considerable variation worldwide on the indications for and timing of initiation and discontinuation of RRT for AKI. Numerous parameters for metabolic, solute and fluid control are generally utilized to guide the initiation and discontinuation of RRT. However, there are currently no standards in this field.
Collapse
Affiliation(s)
- S M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
9
|
Abstract
Acute renal failure is common in the intensive care unit; it is well recognised that patients who develop acute renal failure have a high mortality rate. While there have been improvements in the management of acute renal failure, the mortality remains high. Acute renal failure is easily diagnosed biochemically and clinically but it is not a single disease entity. It is a syndrome that affects a very heterogeneous population. Studies of acute renal failure and of the impact of renal replacement therapy in intensive care are usually inconclusive, which may be the natural consequence of studying a syndrome. This article focuses on the more uncertain features of acute renal failure, the problems of investigating acute renal failure as a disease and the difficulties of applying the results of a study of a heterogeneous population to the management of individuals.
Collapse
Affiliation(s)
- A Tillyard
- Department of Anaesthesia and Intensive Care, Chelsea and Westminster Hospital, London, SW10 9NH, UK.
| | | | | |
Collapse
|