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Группа авторов. 40 Years of Continuous Renal Replacement Therapy
Contributions to Nephrology
40 Years of Continuous Renal Replacement Therapy
Contents
Preface
Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement
Abstract
Introduction
The Era of Continuous Arteriovenous Hemofiltration
The Addition of Diffusion and the Birth of Hemodiafiltration
Ultrafiltration and Fluid Balance Control
Introduction of Venovenous Pumped Techniques
From Adoptive Technology to Dedicated Equipment
Technological Response to New Demands
Evolution of CRRT Techniques
From Renal Replacement to Multiple Organ Support Therapy
Latest Generation of CRRT Machines
Innovation and Consensus on CRRT Technology Requirements
CRRT Connectivity
Specific Technology for Small Infants and Pediatric Applications
Conclusions
References
Evolution of Vascular Access and Anticoagulation
Abstract
Vascular Access. Vascular Access Site and Catheter Positioning
Catheter Colonization and Infection Risk
Catheter Dysfunction
Catheter Lock
Anticoagulation. A Paradigm Shift in Anticoagulation Approach
Prescribing RCA
Side Effects and Complications of RCA
A Practical Bedside Approach. How to Handle…
Conclusions
References
Indications and Timing of Continuous Renal Replacement Therapy Application
Abstract
Introduction
How Is “Timing” Relative to Starting CRRT Defined?
Why Start CRRT?
Why Not Start CRRT?
Current Recommendations from Clinical Practice Guidelines
Can CRRT Improve Outcome?
Recent Trials Examining RRT Initiation Strategies in AKI
Conclusions
Acknowledgments
Disclosure Statement
References
Prescription and Delivery of the Right Continuous Renal Replacement Therapies Dose
Abstract
Introduction
Conceptual Definitions of Dose
Machine Flow-Estimated Dose
Solute Measured-Based Doses
Practical Definitions of Dose: How to Prescribe and Measure the CRRT Dose
The Effects of Delivered Dose on Solute Control
Main Factors Affecting Dose Delivery in CRRT
Quality Indicators for Dose Monitoring
References
Techniques and Modalities of Continuous Renal Replacement Therapy
Abstract
Introduction
Physiologic Principles
Clinical Practice
Integration of CRRT into Multi-Organ Support Systems
ECLS in Respiratory Failure
ECLS in Cardiac Failure
ECLS in Liver Failure
Future Developments
Conclusions
References
Fluid Management on Continuous Renal Replacement Therapy
Abstract
Fluid Homeostasis and the Critically Ill
Fluid Management on CRRT
FB as Target for Patient Care
Principles of Fluid Management Using CRRT
Physiological Targets and Goals for Fluid Management
Rate of Fluid Removal
Monitoring during Fluid Removal
Orders and Charting
Conclusions
References
Membranes and Sorbents
Abstract
Introduction
CRRT Membranes. General Considerations
Specific Treatment Considerations
Sorbents
Technical Aspects of Sorbents
Rationale for the Use of Adsorption in Critical Illness and Specific Modalities
Conclusion
References
Advances in Machine Technology
Abstract
Introduction
Historical Evolution of CRRT Machines
State-of-the-Art CRRT Hardware
User Interface/Screen
Circuit Pumps and Pressure Monitoring
Fluid Balance
Anticoagulation
Conclusion
References
Extra-Renal Indications for Continuous Renal Replacement Therapy
Abstract
Introduction
Incidence of Extra-Renal Indications
Fluid Removal
Removal of Endogenous and Exogenous Substances
Severe Lactic Acidosis
Ammonia
Myoglobin
Tumour Lysis Syndrome
Exogenous Toxins
Removal of Cytokines
Summary
References
Technical Complications of Continuous Renal Replacement Therapy
Abstract
Introduction
Vascular Access
Filter Clotting and Reduced Filter Life and Efficiency
Hypothermia
Air Embolism
Fluid Balance
Others
Conclusions
References
Clinical Complications of Continuous Renal Replacement Therapy
Abstract
Introduction
Hemodynamic Disturbances
Hypovolemia
Myocardial Dysfunction
Systemic Vascular Resistance Changes
Cardiac Arrhythmia
Metabolic Complications. Acid-Base Disorders
Metabolic Acidosis Due to Citrate Accumulation
Metabolic Alkalosis Due to Citrate Overload
Electrolyte Disorders
Hemorrhagic Complications
Hypothermia and Other Constraints Related to CRRT
Undesired Clearance of Metabolites and Drugs
Conclusion
References
Discontinuation of Continuous Renal Replacement Therapy and Dialysis Dependence
Abstract
Understanding Effective Discontinuation
Renal Recovery and Outcomes in Patients with RRT
Predicting Effective Discontinuation and Patterns of CRRT Discontinuation
Conclusions
References
Ensuring Quality of Care through Monitoring of Continuous Renal Replacement Therapies
Abstract
Current State of Technology and Data Capture for Clinical Decision-Making
Incorporating CRRT Treatment Data in Quality Improvement
Real-Time Dynamic Data Use in CRRT to Improve Outcomes
Implementation of Information Technology for CRRT Technologies
Summary
References
Continuous Renal Replacement Therapy Quality Control and Performance Measures
Abstract
Introduction
Current Quality Status of CRRT
Performance Measures of CRRT Quality
CRRT Dose
CRRT Initiation Timing
Filter Lifespan
Clearance Dose
Effective Treatment Time
Fluid Management
Adverse Events
Potential Quality Improvement Methods of CRRT. Extend Filter Lifespan
Dialysis Technique and Device Improvement
Professional Education and Specialized CRRT Team
Conclusion
References
Pediatric Continuous Renal Replacement Therapy for “40 Years of Continuous Renal Replacement Therapy”
Abstract
A Look at the Past
Current Practice and Evidence
Patient Outcomes
Indications for CRRT Initiation
Specific Pediatric CRRT Populations
Technical Characteristics
A Look Toward the Future
References
From Continuous Renal Replacement Therapies to Multiple Organ Support Therapy
Abstract
Introduction
Extracorporeal Blood Purification in Sepsis
High Volume Hemofiltration
Polymixin B Hemoperfusion
High Cutoff Membranes
Coupled Plasma Filtration Adsorption
Lung Support
Liver Support
Cardiac Support
Conclusions
References
Author Index
Subject Index
