An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient An International Consensus Conference in Intensive Care Medicine
An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient An International Consensus Conference in Intensive Care Medicine
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DOI：
10.1164/rccm.200711-1664st
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发表时间：
2010-05-15
影响因子：
24.7
通讯作者：
Polderman, Kees H.
中科院分区：
文献类型：
--
作者：
Brochard, Laurent;Abroug, Fekri;Polderman, Kees H.
目的：方法和问题：在为期2天的研讨会上，专家们讨论了科学顾问提出的5个主要问题，评审团总结了现有的证据：（1）急性肾功能不全（阿基）的识别和定义，该术语由评审团选择;（2）常规ICU护理期间预防阿基;（3）特定疾病的预防，包括肝功能衰竭、肺损伤、心脏手术、肿瘤溶解综合征、横纹肌溶解和腹内压升高;（4）阿基的管理，包括营养、抗凝和透析液成分;（5）肾脏替代治疗对死亡率和恢复的影响。结果和结论：评审团建议使用新定义。阿基显著导致危重患者的发病率和死亡率，充分的容量补充对于预防AKI非常重要，尽管纠正液体不足并不总能预防肾衰竭。晶体液体复苏是有效和安全的，不推荐高渗溶液，因为它们有肾脏风险。肾脏替代治疗是一种维持生命的干预措施，可以为肾脏恢复提供桥梁;没有任何方法被证明是上级的，但谨慎的管理对于改善结局至关重要。
Objectives: To address the issues of Prevention and Management of Acute Renal Failure in the ICU Patient, using the format of an International Consensus Conference.Methods and Questions: Five main questions formulated by scientific advisors were addressed by experts during a 2-day symposium and a Jury summarized the available evidence: (1) Identification and definition of acute kidney insufficiency (AKI), this terminology being selected by the Jury; (2) Prevention of AKI during routine ICU Care; (3) Prevention in specific diseases, including liver failure, lung Injury, cardiac surgery, tumor lysis syndrome, rhabdomyolysis and elevated intraabdominal pressure; (4) Management of AKI, including nutrition, anticoagulation, and dialysate composition; (5) Impact of renal replacement therapy on mortality and recovery.Results and Conclusions: The Jury recommended the use of newly described definitions. AKI significantly contributes to the morbidity and mortality of critically ill patients, and adequate volume repletion is of major importance for its prevention, though correction of fluid deficit will not always prevent renal failure. Fluid resuscitation with crystalloids is effective and safe, and hyperoncotic solutions are not recommended because of their renal risk. Renal replacement therapy is a life-sustaining intervention that can provide a bridge to renal recovery; no method has proven to be superior, but careful management is essential for improving outcome.