Continuous Renal Replacement Therapy (CRRT) is the standard of care for management of critically ill patients with acute renal failure. Part of the Pittsburgh Critical Care series, Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance about this treatment modality, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice. Organized into sections on theory, practice, special situations, and organizational issues, this volume provides a complete view of CRRT theory and practice. Tables summarize and highlight key points, and key studies and trials are included in each chapter. The second edition has been updated to include a new chapter on the use of biomarkers to aid in patient selection and timing, extensive revisions on terminology and nomenclature to match current standards, and the most up-to-date information on newly developed CRRT machines.
Publisher: Karger Medical and Scientific Publishers
Continuous renal replacement therapies (CRRT) started off as an alternative to hemo- or peritoneal dialysis. Today's machines and techniques are the result of 4 decades of developments, studies, and practices which can be divided into 4 distinct stages: exploration and development; birth of a new specialty called critical care nephrology; design of specific new devices and machines; and interaction among various specialists to adapt extracorporeal therapies for multiple organ support and sepsis. This book features contributions from prominent CRRT experts from around the world. It is an important tool for educating a new generation of nephrologists and intensivists. At the same time, it provides the most advanced CRRT users with the latest technological information, the most updated clinical evidence, and the personal opinion of key leaders who contributed to the last 40 years of history in the field.
In the past decade, CRRT has moved from a niche therapy within specific specialty centers to the standard of care for management of critically ill patients with acute renal failure. Continuous Renal Replacement Therapy provides concise, evidence-based, to-the-point bedside guidance about this treatment modality, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice. Organized into sections on Theory; Pratice; Special Situations; and Organizational Issues, Continuous Renal Replacement Therapy provides a complete view of CRRT theory and practice. Generous tables summarize and highlight key points, and key studies and trials are listed in each chapter.
This book provides a current understanding of Continuous Renal Replacement Therapies (CRRT) techniques with a focus on drug dosing in critically ill children receiving CRRT. Strategies include the role of therapeutic drug monitoring, effect of CRRT on drug pharmacokinetics, variations in the drugs properties, newer kidney injury biomarkers and simple and easy methods for estimating drug clearance. The conclusion of this book features case reports focused on the patients’ symptoms and laboratory data as they present in clinical practice and the type of CRRT modality needed to provide quality, safety, and cost-effectiveness of patient care. Pediatric Continuous Renal Replacement Therapy will expand the clinical knowledge and experience of practicing nephrologists and other professionals involved in the care of children suffering from Acute Kidney Injury (AKI) to improve and sustain their quality of life.
A retrospective chart review investigating the difference in continuous renal replacement therapy (CRRT) downtime between an autonomous management by the critical care nurse and a collaborative management between the critical care nurse and dialysis nurse.
Abstract: A 73-year-old man was transferred to the emergency department (ED). He was found unconscious in his house along with an empty 200-mL bottle of Basta TM, a herbicide containing 18% glufosinate. He was comatose with a Glasgow Coma Scale score of 3. As his blood pressure dropped to 60/30 mmHg despite fluids and norepinephrine, 20% intravenous fat emulsion product was injected. He experienced repeated cardiopulmonary arrests during his first 4 h in the ED. When the arrests occurred, standard cardiopulmonary resuscitation was performed, and boluses of fat emulsion were given. He was given a total of 1500 mL of 20% fat emulsion. In an attempt to correct the acidosis, continuous renal replacement therapy (CRRT) was started. Within 5 min of starting CRRT, the transmembrane pressure increased sharply and the machine stopped.
Abstract : ABSTRACT: The intensity of continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) has been evaluated, but recent randomized clinical trials have failed to demonstrate a beneficial impact of high intensity on the outcomes. High intensity might cause some detrimental results recognized recently as CRRT trauma. This study was undertaken to evaluate the association of CRRT intensity with mortality in a population of AKI patients treated with lower-intensity CRRT in Japan. A retrospective single-center cohort study enrolled 125 AKI patients treated with CRRT in mixed intensive care units of a university hospital in Japan. Subanalysis was conducted for septic and postsurgical AKI. The median value of the prescribed total effluent rate was 20.1 (interquartile range 15.3–27.1) mL/kg/h. Overall, univariate Cox regression analysis indicated no association of the CRRT intensity with the 60-day in-hospital mortality rate (hazard ratio 1.006, 95% confidence interval [CI] 0.991–1.018, P = 0.343). In subanalysis with the septic AKI patients, multivariate analysis revealed two factors associated independently with the 60-day mortality rate: the Sequential Organ Failure Assessment score at initiation of CRRT (hazard ratio 1.152, 95% CI 1.025–1.301, P = 0.0171) and the CRRT intensity (hazard ratio 1.024, 95% CI 1.004–1.042, P = 0.0195). The CRRT intensity was associated significantly with higher 60-day in-hospital mortality in septic AKI, suggesting that unknown detrimental effects of CRRT with high-intensity CRRT might worsen the outcomes in septic AKI patients.
Abstract: Hypophosphatemia is a common and potentially serious complication occurring during continuous renal replacement therapy (CRRT). Phosphate supplementation is required in the vast majority of patients undergoing CRRT, particularly beyond the first 48 hours. Supplementation can be provided either as a standalone oral or parenteral treatment or as an additive to CRRT solutions. Each approach has advantages and disadvantages, and clinicians must weigh the individual factors most relevant in their practice setting. Currently there are no consensus protocols for phosphate replacement in CRRT, and many centers replete phosphate in response to hypophosphatemia as opposed to pre‐emptively. Repletion protocols have also been challenged in recent years by shortages in injectable phosphate solutions. More recently a commercially available phosphate‐containing CRRT solution was approved in the United States, but there has been limited clinical experience with this product. In this review, we present recommendations for phosphate repletion in CRRT to prevent hypophosphatemia, and describe our experience using phosphate‐containing CRRT solutions.
The initial observations of dialytic support were brought from the laboratory and confined to patients with reversible acute renal failure. The thought at that time was one of short term maintenance. It was theorized that removal of waste products from the blood, albeit incomplete and inefficient, might allow these patients time to regenerate damaged tubules and regain renal function. After a dis appointing earlier experience in survival, greater sophisti cation and broader practice refined the dialysis skills and reduced mortality. It also became apparent that long periods of support were possible and successful attempts were then made in utilizing this technology in patients with chronic renal failure. These early young patients were a very select group who possessed only renal dysfunction and no other systemic involvement. Nonetheless, they demonstrated a one year survival of only 55-64%. There are presently over 80,000 patients on dialytic support in the United States and over 250,000 patients worldwide dependent on artificial replace ment. Mortality statistics vary but despite a 20-30% systemic disease involvement and a fifth decade average age in the North American experience, the one year survival has risen to apparently 90%.
This book represents an invaluable resource for professionals for the diagnosis and treatment of acute kidney injury (AKI) in children and how to select and deliver the appropriate form of renal replacement therapy (RRT). Experts from all over the globe have come together to share their wide experience in the field of Critical Care Nephrology in children. Paediatric critical care nephrology is a complex and highly specialised field, presenting challenges and management strategies that are often quite distinct from those seen in adult practice. Therefore, it is high time to address all the topics in the field of critical care nephrology in children in a unique book which is the first of its kind. This book covers the basics as well as advances in the field of Critical Care Nephrology. Each chapter is dedicated to practical aspects of a particular topic elucidating various management decision points. Each chapter is also accompanied with algorithms, figures and protocols in tabulated format. Information on how to manage specific conditions are contextualized with relevant background anatomy, physiology and biochemistry and practical examples. At the end of the chapter, there are key learning points. Paediatricians, nephrologists and paediatric intensivists, as well as paediatric critical care and nephrology nurses in all countries will find this book an invaluable reference text.