IMPROVED CARDIOVASCULAR STABILITY DURING CONTINUOUS-MODES OF RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH ACUTE HEPATIC AND RENAL-FAILURE
IMPROVED CARDIOVASCULAR STABILITY DURING CONTINUOUS-MODES OF RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH ACUTE HEPATIC AND RENAL-FAILURE
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DOI：
10.1097/00003246-199303000-00007
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发表时间：
1993-03-01
影响因子：
8.8
通讯作者：
DAVIDSON, AM
中科院分区：
文献类型：
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作者：
DAVENPORT, A;WILL, EJ;DAVIDSON, AM
目的：目的：确定连续模式的肾脏替代治疗与标准的每日间歇治疗相比是否能改善危重患者的心血管稳定性。设计：前瞻性随机对照试验。重症监护病房在四级转诊中心的肝衰竭/移植。患者。32例连续、危重、机械通气的急性肝肾功能衰竭患者。干预措施：患者随机接受间歇性机器血液滤过或连续模式的肾脏替代治疗;连续性动静脉血液滤过（CAVH）或动静脉血液滤过联合透析（CAVHD），前提是颅内压得到控制。测量和主要结果：在32次间歇性机器血液滤过（4小时）治疗期间和25次连续治疗（CAVH和CAVHD）的前5小时期间评估了心输出量、组织氧输送（Do 2）和摄取。在治疗的第一个小时内，间歇性机器血液滤过期间心脏指数降低15 +/- 2%，而连续治疗模式（CAVH/CAVHD）期间无显著变化（3 +/- 3%;p
Objective: To determine whether continuous modes of renal replacement therapy result in improved cardiovascular stability compared with standard daily intermittent treatment in critically ill patients.Design: Prospective, randomized controlled trial.Setting. Intensive care unit in a quaternary referral center for liver failure/transplantation.Patients. Thirty-two consecutive, critically ill, mechanically ventilated patients with combined acute hepatic and renal failure.Interventions: Patients were randomized to treatment with either intermittent machine hemofiltration or continuous modes of renal replacement therapy; continuous arteriovenous hemofiltration (CAVH) or arteriovenous hemofiltration with dialysis (CAVHD), provided intracranial pressure was controlled.Measurements and Main Results: Cardiac output, tissue oxygen delivery (Do2), and uptake were assessed during 32 treatments with intermittent machine hemofiltration (4 hrs) and during the first 5 hrs of 25 continuous treatments (CAVH and CAVHD). During the first hour of treatment, there was a reduction in cardiac index of 15 +/- 2% during intermittent machine hemofiltration compared with no significant change during the continuous modes of treatment (CAVH/CAVHD) (3 +/- 3%;p