[临床医学]ICU中的血液净化指南之我见.ppt

Dose or intensity of CRRT “IVOIRE study” (hIgh Volume in Intensive care)初步结果： Although patients included were more severely ill, overall mortality in the IVOIRE study remains very low (39% at 28 days and 52% at 90 days) compared with the RENAL study. This may be due to the earlier start of treatment at the renal injury level. Awaiting results from this important trial, 35 ml/kg/h should remain the standard dose in septic AKI, particularly in the presence of shock. Joannes-Boyau O, Honore PM: Hemofiltration Study: IVOIRE Study: clinicaltrials. gov ID NC, last Accessed in June 2011. Contents Introduction 1 Type of therapy 2 Timing of CRRT 3 Dose of CRRT 4 Conclusions 5 6 RRT in ICU: Preference Decision about which technique to use depends on: 1. What we want to remove from the plasma RRT in ICU: Preference 2. The patient`s cardiovascular status CRRT causes less rapid fluid shifts and is the preferred option if there is any degree of cardiovascular instability. 3. The availability of resources CRRT is more labour intensive and more expensive than IHD Availability of equipment may dictate the form of RRT RRT in ICU: Preference 4. The clinician`s experience It is wise to use a form of RRT that is familiar to all the staff involved 5. Other specific clinical considerations Convective modes of RRT may be beneficial if the patient has septic shock CRRT can aid feeding regimes by improving fluid management CRRT may be associated with better cerebral perfusion in patients with an acute brain injury or fulminant hepatic failure 许多问题悬而未决 标准与个体化 You are unique! Standard! Key Points It is recommended to define ARF according to the RIFLE classification system into ARFrisk, ARFinjury and ARFfailure. It is recommended to base the decision when to start RRT not only on the severity of ARF, but also on the severity of other organ failure. Initiation of RRT is to be considered in oliguric patients (RIFLErisk-oliguria or RIFLEinjury-oliguria), despite adequate fluid res