20xx年醫(yī)學(xué)專題—icu中的血液凈化指南之我見-資料下載頁
2024-10-31 17:17本頁面
【正文】 erred option if there is any degree of cardiovascular instability. 3. The availability of resources CRRT is more labour intensive and more expensive than IHD Availability of equipment may dictate the form of RRT,第三十四頁，共四十二頁。,RRT in ICU: Preference,4. The clinician`s experience It is wise to use a form of RRT that is familiar to all the staff involved 5. Other specific clinical considerations Convective modes of RRT may be beneficial if the patient has septic shock CRRT can aid feeding regimes by improving fluid management CRRT may be associated with better cerebral perfusion in patients with an acute brain injury or fulminant hepatic failure,第三十五頁，共四十二頁。,許多(xǔduō)問題懸而未決,第三十六頁，共四十二頁。,標(biāo)準(zhǔn)(biāozhǔn)與個(gè)體化,You are unique!,Standard!,第三十七頁，共四十二頁。,Key Points,It is recommended to define ARF according to the RIFLE classification system into ARFrisk, ARFinjury and ARFfailure. It is recommended to base the decision when to start RRT not only on the severity of ARF, but also on the severity of other organ failure. Initiation of RRT is to be considered in oliguric patients (RIFLEriskoliguria or RIFLEinjuryoliguria), despite adequate fluid resuscitation, and/or a persisting steep rise in serum creatinine.,第三十八頁，共四十二頁。,Key Points,RRT may be postponed when the underlying disease is improving, other organ failure recovering and the slope in the serum creatinine rise declines, in order to see if renal function is also recovering. It is recommended 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。,Key Points,The recommended delivered (not prescribed) ultrafiltrate (dialysate) flow during CVVH(D) is 35 mL/kg/h in postdilution. A higher dose applied for a short period may be considered in Sepsis/SIRS. The dose needs to be adjusted for predilution. In nonshock patients, continuous and intermittent treatments are equivalent regarding survival. However, CRRT is recommended over IHD for patients with ARF who have, or are at risk for, cerebral oedema. CRRT is preferred in the management of patients with ARF and shock.,第四十頁，共四十二頁。,Thank You !,第四十一頁，共四十二頁。,內(nèi)容(n232。ir243。ng)總結(jié),ICU中的血液凈化指南之我見。有些研究(y225。njiū)表明在ICU不穩(wěn)定的患者中應(yīng)用IHD也不會(huì)存在明顯的問題, 有RCTs并沒有顯示出CRRT優(yōu)于IHD。AKI的急性期推薦應(yīng)用CRRT，尤其是對(duì)于嚴(yán)重血流動(dòng)力學(xué)不穩(wěn)定、需大量清除液體以便于進(jìn)行更有效藥物治療的患者。專家的意見是患者治療劑量要足夠，至少25 ml/kg/h。Thank You,第四十二頁，共四十二
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