Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltration
Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltration
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DOI：
10.1007/s00134-003-1672-8
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发表时间：
2003-04-01
影响因子：
38.9
通讯作者：
Bellomo, R
中科院分区：
文献类型：
--
作者：
Uchino, S;Fealy, N;Bellomo, R
目的：关于连续性静脉-静脉血液滤过(CVVH)期间患者停止治疗的时间(停机时间)以及这种治疗空闲时间对氮质血症控制的影响的信息很少。设计和地点：三级医院ICU的前瞻性观察研究。患者和对象：48例危重病患者接受CVVH治疗，超滤速度为2.1次/h。干预：前瞻性收集人口学和生化数据。测量和结果：观察到266个滤光片。收集每个过滤器的开始时间和结束时间。每天测量肌酐和尿素，并计算这两种溶质的减少百分比(%肌酐和尿素)。患者未应用CVVH的中位时间(停机时间)为每天3h。在每个24小时周期中，停机时间与%Delta、肌酐和尿素呈显著负相关。平均每天至少需要16小时的CVVH，以维持每24小时周期的肌酐和尿素浓度。结论：“持续”治疗并不是真正的持续治疗。停机时间对固氮素控制有不利影响。开CRRT处方的医生应该意识到这种停机时间对所提供的肾脏替代疗法的质量和数量的影响。
Objective: There is little information on the duration of time that patients spend off therapy (down-time) during continuous veno-venous haemofiltration (CVVH) and the effect of this treatment free time on azotaemic control. Design and setting: Prospective observational study in the ICU of tertiary hospital. Patients and participants: 48 critically ill patients treated with CVVH at 2 1/h of ultrafiltration. Interventions: Prospective collection of demographic and biochemical data. Measurements and results: Two hundred and sixty-six filters were observed. Start and end times were collected for each filter. Creatinine and urea were measured daily and percentage of reduction of these two solutes was calculated (%Delta creatinine and urea). The median period when CVVH was not applied to a patient (down-time) was 3 h per day. There was a significant inverse correlation between down-time and %Delta creatinine and urea over each 24-h time cycle. On average at least 16 h per day of CVVH was required to maintain creatinine and urea concentration for each 24-h cycle. Conclusions: "Continuous" therapy is not truly continuous. Down-time adversely affects azotaemic control. Physicians prescribing CRRT should be aware of the consequences of such down-time on the quality and quantity of renal replacement therapy delivered.