归纳CRRT模式选择.ppt

.精品课件. * 内容提要 CRRT的基本概念 CRRT的溶质清除原理 CRRT的基本模式 CRRT在ICU中的应用 .精品课件. * CRRT治疗方式 * SCUF CVVH CVVHD CVVHDF Access Return Effluent Replacement (pre or post dilution) Access Return Effluent Access Return Effluent Dialysate Replacement (pre orpost dilution) I Access Return Effluent Dialysate .精品课件. Continuous Renal Replacement Therapies SCUF C A V H C VV H C A V HD C VV HD C VV HDF SPONTANEOUS Blood Circulation PUMPED Blood Circulation HEMOFILTRATION CONVECTION HEMODIALYSIS DIFFUSION HVHF .精品课件. * Removal of water is done by UF No Substitution liquid is used Used mainly for CHF + Fluid Overload SCUF (Slow Continuous Ultrafiltration) .精品课件. * CVVHD (Continuous Veno-Venous Hemodialysis) The principle ( clearances ) is Diffusion Eliminate mainly Small Molecules Net Fluid Removal is desired Used of Sterile Dialysate Solution .精品课件. * CVVH Post dilution (Continuous Veno-Venous Hemofiltration) The principle ( clearances ) is Convection Eliminate Small , Mid + Large molecules Net Fluid removal if desired In post-Dilution Fluids are returning after the Filter inside the venous line .精品课件. * Talking about solute management in CRRT can get confusing, but it really quite simple We have solutes in the blood that we want to remove and some that we don’t want to remove. Since all solutes do not have the same characteristics, they cannot all be removed the same way. Diffusion and convection are efficient at removing small molecules Convective clearance is better for larger molecules. Ultrafiltration facilitates the convective process and some substances are adsorbed by the membrane. Resulting in more or less what we want “solute management” Let’s take a look at each principle. Potting material: Hollow fibres can withstand greater pressures generated by pumps than flat plate filters. Flate plate filters reduced resistance to flow therefore well suited to lower driving pressures as CAVH More fragile to prime More risk of fractu