【正文】 Thank You 第四十二頁，共四十二頁。 AKI的急性期推薦應用 CRRT，尤其是對于嚴重血流動力學不穩(wěn)定、需大量去除液體以便于進行更有效藥物治療的患者。 內(nèi)容總結(jié) ICU中的血液凈化指南之我見。 Key Points ? The remended 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 remended 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。 Key Points ? It is remended to define ARF according to the RIFLE classification system into ARFrisk, ARFinjury and ARFfailure. ? It is remended to base the decision when to start RRT not only on the severity of ARF, but also on the severity of other an 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。 許多問題懸而未決 第三十六頁，共四十二頁。 RRT in ICU: Preference ?2. The patient`s cardiovascular status ? CRRT causes less rapid fluid shifts and is the preferred 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。 Contents Introduction 1 Type of therapy 2 Timing of CRRT 3 Dose of CRRT 4 Conclusions 5 6 第三十二頁，共四十二頁。 JoannesBoyau O, Honore PM: Hemofiltration Study: IVOIRE Study: clinicaltrials. gov ID NCT00241228., last Accessed in June 2024. Crit Care 2024, 13:R57. J Nephrol 2024, 24:165176. 第三十頁，共四十二頁。 ? 但實際中由于存在可預測的〔 bags change, nursing...〕和不可預測的〔 surgery, clotting...〕治療中斷，意味著劑量要在 3035 ml/kg/h； ? Septic AKI患者的治療劑量目前仍存在爭議，一些小的前瞻隨機研究說明高劑量的血液濾過是有益的。 Dose or intensity of CRRT ? 而關于 nonseptic AKI 的治療劑量， RENAL研究得到了一個明確的答案 : Randomized Evaluation of Normal versus Augmented Levels (RENAL) study: ? no beneficial effect of CVVHDF at 40 ml/kg/h pared with 25 ml/kg/h. ? Therefore, current consensus suggests a hemofiltration dose of 25 ml/kg/h in nonseptic AKI with no additional benefit from a dose increase. N Engl J Med 2024, 361:16271638. 第二十九頁，共四十二頁。 Dose or intensity of CRRT 第二十七頁，共四十二頁。 Contents Introduction 1 Type of therapy 2 Timing of CRRT 3 Dose of CRRT 4 Conclusions 5 6 第二十五頁，共四十二頁。 Timing of CRRT ? When initiation of RRT is considered, it is i