【持續(xù)性腎臟替代治療crrt英文精品課件】crrt in the icu_第1頁(yè)
【持續(xù)性腎臟替代治療crrt英文精品課件】crrt in the icu_第2頁(yè)
【持續(xù)性腎臟替代治療crrt英文精品課件】crrt in the icu_第3頁(yè)
【持續(xù)性腎臟替代治療crrt英文精品課件】crrt in the icu_第4頁(yè)
【持續(xù)性腎臟替代治療crrt英文精品課件】crrt in the icu_第5頁(yè)
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CVVHintheICU BPLEUNGMD EDICSurgicalICUStMartindePorresHospital ICUPHILOSOPHY 重癥醫(yī)學(xué) The Mystique ThecomplexityofpatientMonitoring supportequipment 重癥醫(yī)學(xué) Finalcommonpathway MultisystemFailure 多重器官衰竭 MultipleOrganFailure Lung Heart KidneyBrainGutImmuneSystem Asingleorgandoctortoday Thegeneralpractitionerofold WhoshouldbeadmittedtoanICU PotentiallyreversibleorganfailureA time limited therapeutictrialRemembernottoplayGodintheICU Principlesofpracticeofcriticalcare PrimumnonnocereTheconsidereduseoftechnologyEarlydiagnosis treatment7 11 CRRTintheICU ContinuousRenalReplacementTherapyCAVHCVVHCVVHDCVVHDFBloodPurification Mechanismsofsoluteremoval DiffusionUltrafiltrationAdsorption RenalReplacementTherapy IntermittentvsContinuousArteriovenousvsVenovenousHaemodialysisvsHaemofiltrationPre dilutionvsPost dilution GlossaryofvarioustypesofRRT PeritonealDialysisPDConventionalHaemodialysisIHDHaemofiltrationContinuousarteriovenoushaemofiltrationCAVHContinuousvenovenoushaemofiltrationCVVHHaemodialysisContinuousarteriovenoushaemodialysisCAVHDContinuousvenovenoushaemodialysisCVVHDHaemodiafiltrationContinuousarteriovenoushaemodiafiltrationCAVHDFContinuousvenovenoushaemodiafiltrationCVVHDF WhichisthebesttechniqueofRRTinICU BiasagainstCRRTConcernsaboutanticoagulationSupervision24hrs dayBetterclinicaloutcome Peopledieanyway itcostsmore WhichisthebesttechniqueofRRTinICU Thesickestpatients havethemosttogainusingCRRT WhichisthebesttechniqueofRRTinICU Tocomplicatetheissuefurther SlowExtendedDailyDialysis SLEDDisbeingincreasingusedEffectofunder dosinginCRRTonoutcomesofARF Impactofdifferenthaemofiltrationdoses 425patientswithARFRandomlyassignedultrafiltrationat 20ml kg h35ml kg h45ml kg hPrimaryendpoint Survivalat15dafterstoppingHF41 57 58 Ronco Lancet2000 WhichisthebesttechniqueofRRTinICU Isacontrolledtrialpossible MultiplecomplicationsincriticallyillpatientsSomepatientstooillforIHDCross overinICUAconsenususdefinitionforARFisneeded EarlyGoaledUltrafiltrationTherapy EarlyGoal DirectedTherapy Notjustforsepsis EarlyGoaledUltrafiltrationTherapy VolumeOptimisationDiuretics EarlyGoaledUFTherapy EarlyGoaledUltrafiltrationTherapy Howaggressive Discrepancybetweenprescribed deliveredclearance Howearly WhatisthecriteriaforinitiatingRRT MagicBullet PeakConcentrationHypothesis ThresholdModulation Magicshield RationaleforHighVolumeHaemofiltration RenalDose vs SepticDose The SIRS OSO Approach Overwhelming Systemic OverflowSocalled spillovermediators Improved Immunodynamics HighVolumeHaemofiltrationHVHF Isthistheendofthestory Howfarshouldwego Ronco CHVHF 3L hx24h PHVHF 6L hx6hHonore 50 100 125mL kg h TechnicallimitsinHVHFBloodAccess14FrCoaxialcatheters BloodTubing MembraneDigitalBalances FullComputerisationNutrientFluxes DrugExchanges TypesofBufferThermalBalance RewarmingProcedure RationaleforHighVolumeHaemofiltration Isthistheendofthestory InvivoexperimentalstudiesinsepticshockThe dose story HumanbeingsarequitelargeanimalsBestresponseinintravascularsepsismodelsTimetodevelopestablishedsepticshockisnotlongenoughHemodynamicsasthekeytarget RationaleforHighVolumeHaemofiltration Isthistheendofthestory RemovalofmediatorsofsepsisExperimentalstudiesinvitroAdsorptionClinicalstudiesPlasmalevelsseldomdecreaseImprovedhemodynamicsevenintheabsenceoffallinplasmacytokinelevels CRRTAnticoagulation UnfractionedheparinSalineflushesPre dilutionRegionalanticoagulationwithprotamineHeparinoidsLow molecular weightheparinsProstacyclinDirectthrombininhibitors HirudinCitrate CitrateAnticoagulation CitratechelatescalciuminextracorporealcircuitNoclottingifcircuitiCa 0 25mmol LOnreturntopatientbloodhasnormalserumiCalevelsCitratemetabolizedtoHCO3 H2OMeanfilterlife 48hrs CitrateAnticoagulation Adverseevents TechnicalerrorsMetabolicalkalosisHypernatremiaProgressiveionizedhypocalcemiaLiverpatientsNocommercialsubstitutionsolution GambroAK10 PrismaBloodflowlimitedtoonly180mL minReplacementflowratelimitedto2000mL hDialysateratelimitedto2500ml hAdedicatedready to connectcircuitAccuracyoffluidbalance 0 45 atmaxflowrates PrismafleXBloodflowupto450mL minReplacementflowupto8000mL hDialysaterateupto8000ml hEffluentremovalupto10L hAccuracyoffluidbalance 10 ofsetrate2pinchvalvesforpre post dilution TheMARS principle TheMARS membrane MARS Combinations I Fresenius4008 GambroAK200 BaxterBM25 SeeHomepageTERAKLIN comoraskTERAKLINRepresentativeforthelatestInformationoncompatibleDialysisMachines ExtracorporealOrganSupportTherapy

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