Precision Continuous Renal Replacement Therapy and Solute Control
Precision Continuous Renal Replacement Therapy and Solute Control
复制标题
DOI：
10.1159/000448507
复制
发表时间：
2016-01-01
影响因子：
3
通讯作者：
Ronco, Claudio
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;Chakravarthi, Madarasu Rajasekara;Ronco, Claudio
连续性肾脏替代疗法(CRRT)仍然是全世界危重患者肾脏支持的主要形式。目前CRRT处方的临床实践大多依赖于高质量的研究，表明CRRT剂量对危重患者的预后没有影响。最近的临床实践指南是在这些研究的基础上制定的，建议CRRT的静态处方剂量为20-25ml/kg/h。基于适应危重患者不断变化的临床需求的动态溶质控制的概念，有理由重新关注CRRT处方/实践。作为回应，急性疾病质量倡议召开了第17次共识会议，重点是重新评估CRRT。该工作组制定了4个主题，专门侧重于CRRT剂量处方、给药和溶质控制，并在一系列共识声明中进行了总结，同时确定了关键知识差距。CRRT剂量处方和投药可根据出水流量确定。应定期监测给药剂量，以确保与处方剂量一致。CRRT剂量应该是动态的，以识别患者之间和患者内部在靶向溶质控制或意外溶质清除方面的差异。已经提出了监测CRRT投放剂量的具体质量措施，需要在实施之前进一步验证，以指导最佳CRRT剂量的实践。(C)2016年S.Karger AG，巴塞尔
Continuous renal replacement therapy (CRRT) remains the dominant form of renal support among critically ill patients worldwide. Current clinical practice on CRRT prescription mostly relies on high quality studies suggesting no impact of CRRT dose on critically ill patients' outcomes. Recent clinical practice guidelines have been developed based on these studies recommending a static prescribed CRRT dose of 20-25 ml/kg/h. There is a rationale for renewed attention to CRRT prescription/practice based on the concept of dynamic solute control adapted to the changing clinical needs of critically ill patients. In response, Acute Disease Quality Initiative convened a 17th consensus meeting centered on reevaluation of CRRT. This work group developed 4 themes focused specifically on CRRT dose prescription, delivery and solute control that were summarized in a series of consensus statements, along with the identification of critical knowledge gaps. CRRT dose prescription and delivery can be based on effluent flow rate. Delivered dose should be routinely monitored to ensure coherence with prescribed dose. CRRT dose should be dynamic, in recognition of between-and within-patient variation in targeted solute control or unintended solute clearance. Quality measures specific for monitoring delivered CRRT dose have been proposed that require further validation, prior to implementation, into the practice of guiding optimal CRRT dosage. (C) 2016 S. Karger AG, Basel