icu中的血液凈化指南之我見-文庫吧資料
2024-10-04 07:45本頁面
【正文】 mportant to realize that: ? the consequences of ureamic toxicity, metabolic acidosis and/or fluid overload are likely to be more severe in the critically ill patient. ? Moreover, renal function is unlikely to recover within a short period during persistent and severe failure of other ans. ? Furthermore, various inflammatory mediators are cleared by the kidney. 第二十三頁，共四十二頁。 Timing of CRRT ? 目前廣為接受的 Septic AKI開始 RRT時機，尤其是在 septic shock 時： RIFLE injury stage (or AKIN stage 2) ? but consensus on this topic awaits results from largescale RCTs. 第二十一頁，共四十二頁。 Timing of CRRT ? There is significant variation in the timing of initiation of RRT, with up to twofold differences in the reported values of BUN, creatinine, or urine output at RRT initiation. Clinical studies evaluating the timing of initiation of CRRT in critically ill patients 第十九頁，共四十二頁。 Contents Introduction 1 Type of therapy 2 Timing of CRRT 3 Dose of CRRT 4 Conclusions 5 6 第十七頁，共四十二頁。 ? 有些研究說明在 ICU不穩(wěn)定的患者中應(yīng)用 IHD也不會存在明顯的問題 , 有RCTs并沒有顯示出 CRRT優(yōu)于 IHD Type of therapy Kidney Int 2024,76:422427. BMC Nephrol 2024, 11:32. Nephrol Dial Transplant 2024, 24:512518. Lancet 2024,368:379385. ? 對于依賴血管活性藥物的 AKI患者， CRRT才是最適合的； ? 依賴血管活性藥物的 AKI患者將來接受長期透析的幾率 CRRT 間斷性治療； ? AKI的急性期推薦應(yīng)用 CRRT，尤其是對于嚴(yán)重血流動力學(xué)不穩(wěn)定、需大量去除液體以便于進(jìn)行更有效藥物治療的患者。 ? IHD use was mostly restricted to ICUs in north and south America, where it was used as initial therapy in 30–40% of patients, while, by contrast, CRRT is used first in 100% of ICUs in Australia. ?Among patients receiving CRRT, however, marked variation in the modality, intensity, timing was observed ? Making it difficult to pare outes between patients on CRRT and those on IHD Nat. Rev. Nephrol. 2024:6:521–529. 第十四頁，共四十二頁。 Type of therapy ? Clinical studies of CRRT in the ICU ? The diversity of clinical approaches to the treatment of AKI in the ICU is illustrated by the results of the BEST Kidney study, ? The multinational epidemiological study of RRT practice in the ICU ? Study documented the treatment of AKI in 1,738 patients in 54 ICUs on five continents Nat. Rev. Nephrol. 2024:6:521–529. 第十三頁，共四十二頁。 Type of therapy ? These advantages have contributed to the widespread uptake of CRRT as the firstchoice RRT in ICUs throughout Australia, Japan and Europe. ? In these regions, CRRT is usually initiated and managed within the ICU, with RRT being integrated with other aspects of the management of critical illness Nat. Rev. Nephrol. 2024:6:521–529. 第十一頁，共四十二頁。 PEPA = polyether polymer alloy Contrib Nephrol. Basel, Karger,
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