ICU中的血液净化指南之我见.pptxVIP

ICU中的血液净化指南之我见第1页/共42页第2页/共42页Contents1Introduction Type of therapy2Timing of CRRT3Dose of CRRT4Conclusions56第3页/共42页IntroductionMethods of extracorporeal renal replacement therapy (RRT) have been used for the supportive treatment of AKI for over 60 years.CRRT for the critically ill patient with ARF was introduced in 1977 by Kramer et al. Since then, many studies have reported on CRRT in the critically ill.Klin Wochenschr 1977;55:1121-1122.第4页/共42页IntroductionBut for several reasons comparison among studies is difficult: Various treatment modalities have been applied in heterogeneous populations. Differences in clinical setting and underlying molecular biological mechanisms that initiate and maintain ARF. Furthermore, more than 35 definitions of ARF.Practice patterns vary widely between individual centers.Up to now, there are no standard guidelines for the application of CRRT in critically ill patients.Curr Opin Crit Care 2002;8:509-514.第5页/共42页IntroductionThe RIFLE Classification for acute renal failure Crit Care 2004;8:R204-R212.第6页/共42页IntroductionConclusions:More then 200 different definitions of ARF and about 90 RRT start criteria were reported. Oliguria and RIFLE were the most frequent criteria used to define ARF. RIFLE criteria might show a clinical impact on future daily practice and research.Different RRT techniques are available in most centers, but a general lack of treatment dose standardization is noted by our survey. Non-renal indications to RRT still need to find a definitive role in routine practice.Nephrol Dial Transplant (2006) 21: 690–696第7页/共42页IntroductionIn the past, the interaction between nephrology and intensive care was minimal.Today, there is continuous interaction with several moments of high interaction due to common patients and complex syndromes, and much of the treatment of AKI has moved from the renal ward into ICUs. Contrib Nephrol. Basel, Karger, 2010 (166):1–3第8页/共42页Contents1Introduction Type of therapy2Timing of CRRT3Dose or in