Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 15

Arteriovenous therapies were simple because they did not require a peristaltic blood pump, but the morbidity associated with arterial cannulation was substantial. For this reason, venovenous techniques utilizing a double-lumen central venous catheter for vascular access were considered preferable and safe. Thus, within a few years, continuous venovenous hemofiltration or continuous venovenous hemodiafiltration replaced CAVH because of its improved performance and safety. The advance was made possible by the use of blood pumps, calibrated ultrafiltration control systems, and double-lumen venous catheters. These treatment methods were widely utilized at the end of the 1980s and showed excellent uremic control utilizing high blood flows (150 mL/min or more) and large membrane surface areas (0.8 m² or more). To facilitate nursing care, ultrafiltration was soon controlled by devices with reasonable precision. Thus, for clinical purposes, ultrafiltration and reinfusion could be fully regulated to achieve the desired therapeutic goals. This era was characterized, however, by the adoption of technology from other fields (e.g., such as chronic hemodialysis), and multiple devices (blood pump, UF pump, reinfusion pump, anticoagulation, etc.) were connected to the patient without a systematic assembly and a coherent combined strategy. Although efficiency was highly improved and treatment performance was superior to any previous technique, this approach led to potential errors and treatment failures due to the inability of different devices to communicate and operate together.