【正文】 duction 1 Type of therapy 2 Timing of CRRT 3 Dose of CRRT 4 Conclusions 5 6 第二頁，共四十二頁。 ? In the past, the interaction between nephrology and intensive care was minimal. ? Today, there is continuous interaction with several moments of high interaction due to mon patients and plex syndromes, and much of the treatment of AKI has moved from the renal ward into ICUs. Introduction Contrib Nephrol. Basel, Karger, 2024 (166):1–3 第七頁，共四十二頁。 Type of therapy ? In north America, however, traditional structures of ICU management favor an ‘openICU’ approach: ? Within this model, RRT is usually prescribed by a nephrologist in the ICU and is initiated by a dialysis nurse ? In this environment, IHD has the advantage of requiring only daily or alternateday attendance by the renal team ? Conversely, the relative labor costs of providing CRRT are increased, an effect that is pounded by the larger fixed costs and higher consumable requirements of CRRT ? These logistic factors have led to a preference for IHD over CRRT being maintained in ICUs that use the north American. Nat. Rev. Nephrol. 2024:6:521–529. 第十二頁，共四十二頁。 Timing of CRRT ? The right time to start RRT is still a topic of debate. ? 主要的原因的是： ? 沒有一個明確的、協(xié)商一致的 AKI定義能夠根據(jù)腎損傷程度對患者進行分級 ? 研究時很難獲得同種類相同特征的患者組人群 ? RIFLE和 AKIN分級標準使對于 AKI的研究向前邁進了一大步 ? 兩種分級標準均能使臨床醫(yī)生警惕 AKI的出現(xiàn)，進行早期干預 Crit Care 2024, 13:211. 第十八頁，共四十二頁。 Dose or intensity of CRRT 第二十六頁，共四十二頁。 Dose or intensity of CRRT ? “IVOIRE study〞 (hIgh Volume in Intensive care)初步結果： ? Although patients included were more severely ill, overall mortality in the IVOIRE study remains very low (39% at 28 days and 52% at 90 days) pared with the RENAL study. This may be due to the earlier start of treatment at the renal injury level. ? Awaiting results from this important trial, 35 ml/kg/h should remain the standard dose in septic AKI, particularly in the presence of shock. JoannesBoyau O, Honore PM: Hemofiltration Study: IVOIRE Study: clinicaltrials. gov ID NCT00241228., last Accessed in June 2024. 第三十一頁，共四十二頁。 Key Points ? RRT may be postponed when the underlying disease is improving, other an failure recovering and the slope in the serum creatinine rise declines, in order to see if renal function is also recovering. ? It is remended to continue RRT as long as the criteria defining severe oliguric ARF (RIFLEfailureoliguria) are present. If the clinical condition improves, it may be considered to wait before connecting a new circuit to see whether renal function recovers. RRT should be restarted in case of clinical or metabolic deterioration. 第三十九頁，共四十二頁。