Academic literature on the topic 'Continuous renal replacement therapy (CRRT)'
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Journal articles on the topic "Continuous renal replacement therapy (CRRT)"
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Warrillow, Stephen, Caleb Fisher, Heath Tibballs, Michael Bailey, Colin McArthur, Pia Lawson-Smith, Bheemasenachar Prasad, et al. "Continuous renal replacement therapy and its impact on hyperammonaemia in acute liver failure." Critical Care and Resuscitation 22, no. 2 (June 1, 2020): 158–65. http://dx.doi.org/10.51893/2020.2.oa6.
Full textAbstract:
Objective: Hyperammonaemia contributes to complications in acute liver failure (ALF) and may be treated with continuous renal replacement therapy (CRRT), but current practice is poorly understood. Design: We retrospectively analysed data for baseline characteristics, ammonia concentration, CRRT use, and outcomes in a cohort of Australian and New Zealand patients with ALF. Setting: All liver transplant ICUs across Australia and New Zealand. Participants: Sixty-two patients with ALF. Main outcome measures: Impact of CRRT on hyperammonaemia and patient outcomes. Results: We studied 62 patients with ALF. The median initial (first 24 h) peak ammonia was 132 mol/L (interquartile range [IQR], 91–172), median creatinine was 165 mol/L (IQR, 92–263) and median urea was 6.9 mmol/L (IQR, 3.1–12.0). Most patients (43/62, 69%) received CRRT within a median of 6 hours (IQR, 2–12) of ICU admission. At CRRT commencement, three-quarters of such patients did not have Stage 3 acute kidney injury (AKI): ten patients (23%) had no KDIGO creatinine criteria for AKI, 12 (28%) only had Stage 1, and ten patients (23%) had Stage 2 AKI. Compared with non-CRRT patients, those treated with CRRT had higher ammonia concentrations (median, 141 mol/L [IQR, 102–198] v 91 mol/L [IQR, 54–115]; P = 0.02), but a nadir Day 1 pH of only 7.25 (standard deviation, 0.16). Prevention of extreme hyperammonaemia (> 140 mol/L) after Day 1 was achieved in 36 of CRRT-treated patients (84%) and was associated with transplant-free survival (55% v 13%; P = 0.05). Conclusion: In Australian and New Zealand patients with ALF, CRRT is typically started early, before Stage 3 AKI or severe acidaemia, and in the presence hyperammonaemia. In these more severely ill patients, CRRT use was associated with prevention of extreme hyperammonaemia, which in turn, was associated with increased transplant-free survival.
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Hidin, Muja, Yasir Teuku, and Dzaky.A.N. "Continuous Renal Replacement Therapy: A Review." Journal of Anesthesiology and Clinical Research 1, no. 2 (December 31, 2020): 63–77. http://dx.doi.org/10.37275/jacr.v1i2.212.
Full textAbstract:
ABSTRACT
Kidney is an important organ to maintain hemodynamic stability inside the human body. In patient with acute kidney injury (AKI) there was a decreased kidney function that could interfere hemodynamic stability which can lead to multi organ failure even death. Around 5-10% patients with AKI required renal replacement therapy (RRT) to support their decreased renal function. Continuous renal replacement therapy (CRRT) is one of RRT modality that commonly used for patients with AKI who are hemodynamically unstable or in critically ill conditions.
CRRT could divided into 4 mode, slow continuous ultrafiltration (SCUF), continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodialfiltration (CVVHDF). CRRT used based on renal and nonrenal indication. Several studies are still trying to prove nonrenal indication of RRT, to ascertain whether CRRT could be used as therapy effectively. Therefore the indication, the mechanism and the comparison of renal replacement therapy are very important to be understood.
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Hidin, Muja, Yasir Teuku, and Dzaky.A.N. "Continuous Renal Replacement Therapy: A Review." Journal of Anesthesiology and Clinical Research 1, no. 2 (December 31, 2020): 63–77. http://dx.doi.org/10.37275/jacr.v1i2.212.
Full textAbstract:
ABSTRACT
Kidney is an important organ to maintain hemodynamic stability inside the human body. In patient with acute kidney injury (AKI) there was a decreased kidney function that could interfere hemodynamic stability which can lead to multi organ failure even death. Around 5-10% patients with AKI required renal replacement therapy (RRT) to support their decreased renal function. Continuous renal replacement therapy (CRRT) is one of RRT modality that commonly used for patients with AKI who are hemodynamically unstable or in critically ill conditions.
CRRT could divided into 4 mode, slow continuous ultrafiltration (SCUF), continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodialfiltration (CVVHDF). CRRT used based on renal and nonrenal indication. Several studies are still trying to prove nonrenal indication of RRT, to ascertain whether CRRT could be used as therapy effectively. Therefore the indication, the mechanism and the comparison of renal replacement therapy are very important to be understood.
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Bagshaw, Sean M., Madarasu Rajasekara Chakravarthi, Zaccaria Ricci, Ashita Tolwani, M. Neri, S. De Rosa, John A. Kellum, and Claudio Ronco. "Precision Continuous Renal Replacement Therapy and Solute Control." Blood Purification 42, no. 3 (2016): 238–47. http://dx.doi.org/10.1159/000448507.
Full textAbstract:
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 re-evaluation 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.
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Mujahidin, Yasir Teuku, and Dzaky. A. N. "Continuous Renal Replacement Therapy: A Review." Journal of Anesthesiology and Clinical Research 1, no. 2 (December 9, 2021): 63–77. http://dx.doi.org/10.37275/jacr.v1i2.138.
Full textAbstract:
Kidney is an important organ to maintain hemodynamic stability inside the human body. In patient with acute kidney injury (AKI) there was a decreased kidney function that could interfere hemodynamic stability which can lead to multi organ failure even death. Around 5-10% patients with AKI required renal replacement therapy (RRT) to support their decreased renal function. Continuous renal replacement therapy (CRRT) is one of RRT modality that commonly used for patients with AKI who are hemodynamically unstable or in critically ill conditions.CRRT could divided into 4 mode, slow continuous ultrafiltration (SCUF), continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodialfiltration (CVVHDF). CRRT used based on renal and nonrenal indication. Several studies are still trying to prove nonrenal indication of RRT, to ascertain whether CRRT could be used as therapy effectively. Therefore the indication, the mechanism and the comparison of renal replacement therapy are very important to be understood.
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Brownback, Cherylynn A., Patricia Fletcher, Lynelle N. B. Pierce, and Susan Klaus. "Early Mobility Activities During Continuous Renal Replacement Therapy." American Journal of Critical Care 23, no. 4 (July 1, 2014): 348–51. http://dx.doi.org/10.4037/ajcc2014889.
Full textAbstract:
Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies.
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Akhoundi, Abbasali, Balwinder Singh, Myriam Vela, Sanjay Chaudhary, Myles Monaghan, Gregory A. Wilson, John J. Dillon, et al. "Incidence of Adverse Events during Continuous Renal Replacement Therapy." Blood Purification 39, no. 4 (2015): 333–39. http://dx.doi.org/10.1159/000380903.
Full textAbstract:
Background/Aims: The incidence of adverse events (AEs) in adults who receive continuous renal replacement therapy (CRRT) is unknown. We report the incidence of mechanical, metabolic, and hemodynamic CRRT AEs. Methods: This is a retrospective study of all consecutive adult patients (≥18 years) who underwent CRRT from January 1, 2007 to December 31, 2009. Results: Out of 595 patients who underwent CRRT, 366 (62%) were male and 500 (84%) were Caucasian. Regional citrate anticoagulation was used in 98.6% of all patients. The most common clinically significant electrolyte derangements were ionized hypocalcemia (22%), ionized hypercalcemia (23%), and hyperphosphatemia (44%). Almost all (97%) patients had at least one additional AE including new onset hypotension (within the first hour after CRRT initiation) (43%), hypothermia (44%), new onset arrhythmias (29%), new onset anemia (31%) and thrombocytopenia (40%). Conclusions: ICU patients who require CRRT have a high incidence of AEs. Although the extent to which these complications are attributable to CRRT is not known, clinicians need to be cautious and aware of their high prevalence in this patient population.
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Murugan, Raghavan, Eric Hoste, Ravindra L. Mehta, Sara Samoni, Xiaoqiang Ding, Mitchell H. Rosner, John A. Kellum, and Claudio Ronco. "Precision Fluid Management in Continuous Renal Replacement Therapy." Blood Purification 42, no. 3 (2016): 266–78. http://dx.doi.org/10.1159/000448528.
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Fluid management during continuous renal replacement therapy (CRRT) in critically ill patients is a dynamic process that encompasses 3 inter-related goals: maintenance of the patency of the CRRT circuit, maintenance of plasma electrolyte and acid-base homeostasis and regulation of patient fluid balance. In this article, we report the consensus recommendations of the 2016 Acute Disease Quality Initiative XVII conference on ‘Precision Fluid Management in CRRT'. We discuss the principles of fluid management, describe various prescription methods to achieve circuit integrity and introduce the concept of integrated fluid balance for tailoring fluid balance to the needs of the individual patient. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for fluid management in patients undergoing CRRT. Finally, we identify and highlight areas of uncertainty in fluid management and set an agenda for future research.
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Nishimi, Saeko, Hiroshi Sugawara, Chinatsu Onodera, Yukiko Toya, Hiromi Furukawa, Yu Konishi, Genichiro Sotodate, Atsushi Matsumoto, Ken Ishikawa, and Kotaro Oyama. "Complications During Continuous Renal Replacement Therapy in Critically Ill Neonates." Blood Purification 47, Suppl. 2 (2019): 74–80. http://dx.doi.org/10.1159/000496654.
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Background/ Aims: Owing to practical and technical developments, continuous renal replacement therapy (CRRT) has been administered even in critically ill neonates. In this study, the complications in CRRT for neonates were examined to establish a safe CRRT. Methods: This retrospective study reviewed the clinical records of neonates who underwent CRRT at our neonatal intensive care unit between 2009 and 2017. Results: Eight neonates with a body weight of 1,462–3,288 g were treated by 70 CRRT sessions with blood priming. Intradialytic hypotension (IDH) was observed in 39 sessions (55.7%), most of which occurred soon after the start of the CRRT. Body temperature decreased in 48 sessions (70.5%), and thrombocytopenia during CRRT occurred 30 times (42.9%). Conclusion: Complications during CRRT in neonates comprised IDH at the start of the CRRT, body temperature decline, and thrombocytopenia. These complications need to be analyzed for a safe neonatal CRRT.
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Yetimakman, Ayse Filiz, Selman Kesici, Murat Tanyildiz, Umut Selda Bayrakci, and Benan Bayrakci. "A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy." Journal of Intensive Care Medicine 34, no. 11-12 (August 18, 2017): 985–89. http://dx.doi.org/10.1177/0885066617724339.
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Background: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. Materials and Method: A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. Results: The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. Conclusion: The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.
Dissertations / Theses on the topic "Continuous renal replacement therapy (CRRT)"
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Davies, Hugh Thomas. "A randomised comparative crossover study to assess the affect on circuit life of varying pre-dilution volumes associated with continuous veno-venous haemofiltration (CVVH) and continuous veno-venous haemodiafiltration (CVVHDf)." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/205.
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Continuous renal replacement therapy (CRRT) is an established treatment option in Australia for critically ill patients with acute renal failure (ARF). Critical care nurses play a primary role in the set-up of equipment, monitoring and care of patients receiving CRRT. Although described as a continuous therapy, delays or interruptions in CRRT can interfere with treatment efficiency. A review of the literature identified how optimal circuit function is an important factor in determining the effectiveness of treatment and patient outcomes.The aim of this research was to evaluate treatment efficiency in terms of circuit life between two widely used forms of CRRT, continuous veno-venous haemofiltration (CVVH) versus continuous veno-venous haemodiafiltration (CVVHDf). The investigation focused attention on the influence higher pre-dilution volumes and convective clearance of CVVH may have on circuit life when compared to the lower pre-dilution volumes and diffusive clearance required for CVVHDf.This thesis describes how the impact of CVVH versus CVVHDf on circuit life was investigated using a randomised comparative crossover study design. Once institutional ethics committee approval had been received, 45 patients were recruited to the study who were 18 years or older and required the commencement of CRRT as part of their Intensive Care treatment. Of the 45 patients who were randomised to receive CVVH or CVVHDf, 31 patients achieved a successful crossover to the alternative technique. Failure to achieve a „natural‟ circuit life – that is one which terminated due to clotting, in a CVVH and CVVHDf circuit accounted for the large drop out rate. Blood flow rate, vascular access device and insertion site, haemofilter, anticoagulation and machine hardware were standardised. An ultrafiltrate dose 35 millilitres (ml) per kilogram (kg) per hour (hr) delivered pre-filter was used for CVVH and a fixed pre-dilution volume of 600ml per hr with a dialysate dose of 1litre (L) was used for CVVHDf. Patients were excluded if coagulopathic, thrombocytopenic or unable to receive heparin.Of the 31 paired comparisons there was a significant difference in circuit life measurements between CVVH and CVVHDf after a paired-sample t-test was performed following natural logarithm base-e (ln) dataset transformation (CVVH 6.101 versus CVVHDf 6.779, P-value = 0.001). A Wilcoxon signed ranks test used raw dataset values of circuit life measurements as an alternative non-parametric comparison (Z = -4.076, P-value < 0.001).The probability of circuit survival for each treatment mode was estimated using the Kaplan-Meir method from the 93 circuits which had survived to clotting (50 CVVH circuits and 43 CVVHDf circuits). Using the truncation point of 16 hr as a measure of expected minimum survival, 50 percent (%) of CVVHDf circuits remained in operation when compared with only a 5% for CVVH circuits. The same 93 circuits were also used in a linear multiple regression analysis. None of the independent variables (activated prothrombin time, platelet count, heparin dose, patient haematocrit, urea) had a coefficient partial correlation > 0.09 (coefficient of determination = 0.117) or a linear relationship which could be associated with circuit life (P-value = 0.228).The evaluation of treatment efficiency in terms of circuit life between the different techniques of CVVH and CVVHDF is of clinical importance, since each treatment mode depends upon a measure of circuit longevity to achieve adequate replacement of renal function. Numerous factors have been described which influence circuit life in the delivery of CRRT including circuit and filter design, anticoagulation and staff training and expertise. In this study a longer circuit life was reported using CVVHDf which incorporated lower pre-dilution volumes when compared with the higher pre-dilution volumes associated with CVVH. This could possibly be explained by the physical processes involved in fluid and solute transport across the filter membrane. The choice of CRRT mode is a factor which may be an important independent determinant of circuit life using the techniques of CVVH and CVVHDf. This information may influence intensive care nursing practice in respect of mode selection for CRRT in collaboration with medical colleagues.
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Alasmari, Hajar Ali M. "Examining intensive care nurses' clinical decision-making associated with acute kidney injury and continuous renal replacement therapy in Saudi Arabia." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122877/1/Hajar%20Ali%20M_Alasmari_Thesis.pdf.
Full textAbstract:
This thesis explored the dimensions of decision-making of nurses managing continuous renal replacement therapy in the intensive care unit. Variations in the levels of decision-making were largely the result of contextual factors including workforce characteristics, management practices, socialisation and organisational constraints. The concepts also constitute an explanation of the ways in which the interplay of social, organisational and technological boundaries constructed the process of nursing clinical decision-making and performance with advanced technology. These finding suggest that there is an urgent need for organisational and social change in the nursing profession in Saudi Arabia.
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Khadzhynov, Dmytro [Verfasser]. "Incidence and outcome of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation / Dmytro Khadzhynov." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1067441840/34.
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Ulldemolins, Gómez Marta. "Optimization of meropenem and piperacillin dosing in critically ill patients with septic shock and acute kidney injury requiring continuous renal replacement therapy: a pharmacokinetic and pharmacodynamic study." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/585924.
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BACKGROUND:
Early and appropriate antibiotic administration has been shown to be the most effective intervention for reducing mortality in critically ill patients with septic shock and multiple organ dysfunction syndrome (MODS). However, despite its relevance, antibiotic dosing in those patients with MODS including acute kidney injury (AKI) that require continuous renal replacement therapy (CRRT) still represents a major challenge for clinicians. In our environment, the broad[spectrum beta[lactams meropenem and piperacillin (in combination with tazobactam) are the antibiotics most frequently prescribed to these patients with very high levels of sickness severity. The impact of septic shock, AKI and CRRT on these antibiotics’ dose requirements is vital, as medical interventions and the disease itself are likely to produce significant variations in their pharmacokinetics (PK), which may lead to alterations in drug concentrations over time and hence compromise the achievement of drug concentrations within the therapeutic range. However, it is still very complex to individualize piperacillin and meropenem dosing in patients with septic shock and AKI necessitating CRRT.
HYPOTHESIS:
Meropenem and piperacillin dosing is not optimal in critically ill patients with septic shock and AKI requiring CRRT due to disease and medical[driven variations in antibiotic PK and, therefore, in dose requirements, which may lead to failure in the achievement of therapeutic concentrations.
AIMS:
1. To evaluate the suitability of current meropenem and piperacillin dosing recommendations in critically ill patients with septic shock and AKI necessitating CRRT;
2. To identify the sources of variability that compromise optimal drug dosing in this patient population; and
3. To develop new recommendations that allow dose individualization considering these variability sources.
METHODS:
Three studies have been developed under the study hypothesis and aims.
Study 1: Literature review. A systematic literature review and critical evaluation of the available evidence on meropenem and piperacillin dosing in critically ill patients with septic shock and AKI necessitating CRRT has been performed.
Studies 2 and 3: Characterization of the PK of meropenem and piperacillin in critically ill patients with septic shock and AKI necessitating CRRT. Two observational, prospective, multicenter, open[label pharmacokinetic studies have been performed in the Intensive Care Units from three Spanish tertiary hospitals. Thirty patients with septic shock and CRRT receiving meropenem and 19 patients receiving piperacillin have been enrolled. Two population PK models have been developed and subsequently validated with data from these patients, and Monte Carlo simulations have been undertaken using NONMEM v.7.3®.
RESULTS:
The main finding of study 1 is that present “oneTsizeTfitsTall” dosing recommendations for meropenem and piperacillin in critically ill patients with septic shock and AKI requiring CRRT are based on studies with some drawbacks, such as: 1) different sickness severities and levels of renal function, 2) different admission diagnostics (medical versus surgical versus trauma), 3) different clinical managements mainly CRRT settings, 4) heterogeneous PK methodologies, and 5) different PD targets for dosing recommendations. This scenario limits extrapolation of their conclusions to our patient population.
Later on, studies 2 and 3 have identified important sources of meropenem and piperacillin PK variability that may assist in dose individualization. For meropenem, the main finding of the population PK analysis is the relationship existing between the 24h urine output and meropenem total clearance (CL). Patients with conserved diuresis (>500mL/24h) exhibit at least a 30% increase in meropenem total CL compared to those patients who are anuric (<100mL/24h), increase that is directly proportional to urine volume. Following Monte Carlo simulations based on this population PK model have shown that for maintaining unbound concentrations of meropenem above the minimum inhibitory concentration (MIC) of the bacteria for a 100% of the dosing interval (100%
FuT>MIC), oligoanuric patients (residual diuresis 0[500mL/24h) require 500mg/q8h over 30min for the treatment of susceptible bacteria (MIC<2mg/L), while patients with preserved diuresis (>500 mL/24h) require the same dose over a 3h[infusion. If bacteria with MIC close to the resistance breakpoint (2[4mg/L) are to be treated with meropenem, a dose of 500mg/q6h is necessary: over a 30min[bolus for oligoanuric patients and over a 3h[infusion for patients with preserved diuresis. For the attainment of more conservative PD targets (40% FuT>MIC), 500mg/q8h over a 30min[bolus is sufficient regardless of residual diuresis
With regards to piperacillin, the main finding of the population PK analysis is the relationship existing among the type of membrane used for CVVHDF, the patient’s weight and piperacillin total CL; for a body weight of 80kg, piperacillin total CL is doubled when a 1.5m2 AN69 acrylonitrile and sodium methallyl sulfonate copolymer filter pre[ coated with heparin and polyethyleneimine (AN69ST) is used compared to the CL for a 0.9m2 AN69 filter. Subsequent Monte Carlo simulations have shown that for a PD target of 100% FuT>MIC, patients receiving CVVHDF with 1.5m2 AN69ST membranes require doses of 4000mg/q8h for the treatment of bacteria with a susceptibility to piperacillin close to the clinical breakpoint (MIC = 8[16mg/L). In contrast, 2000mg/q8h are sufficient for patients with CVVHDF using 0.9m2AN69 membranes. For the treatment of bacteria with high susceptibility to piperacillin (MIC ≤ 4mg/L) or for the attainment of a more conservative PD target (50% FuT>MIC), 2000mg/q8h are sufficient in all cases.
CONCLUSIONS:
Due to data heterogeneity, current meropenem and piperacillin dosing recommendations for patients with septic shock and CRRT follow a one[size[fits[all fashion, which often translates into a best[guess dosing at the bedside. In this context, we have shown that identification and consideration of clinical and demographic parameters that influence meropenem and piperacillin PK, such as 24h urine output, patient’s weight and type of CRRT membrane, is advantageous for dose titration. As they are characteristics easy to be measured at the bedside, the implementation of our research findings in the real clinical setting is easy and may be helpful in the complex process of optimization of antibiotic use in the Intensive Care Unit.L’administració precoç d’antibioteràpia apropiada ha demostrat ser la intervenció més eficaç per reduir la mortalitat en pacients crítics amb xoc sèptic i síndrome de disfunció multiorgànica (SDMO). Malgrat la seva rellevància, però, la dosificació antibiòtica en els pacients amb SDMO incloent insuficiència renal aguda (IRA) que requereixen teràpia continua de suport renal (TCSR) encara representa un repte diari pels professionals de la salut. Al nostre medi, els antibiòtics beta[lactàmics d’ampli espectre meropenem i piperacilelina (en combinació amb tazobactam) són els antibiòtics més prescrits a aquests pacients d’altíssima complexitat i gravetat. L'impacte del xoc sèptic, la IRA i la TCSR en els requeriments de dosis d'aquests fàrmacs és vital, ja que tant la pròpia malaltia com les intervencions mèdiques produeixen alteracions significatives en la seva farmacocinètica (FC), que duen a variacions en els perfils concentració[temps i, conseqüentment, comprometen l'assoliment de concentracions del fàrmac dins del rang terapèutic. No obstant això, individualitzar la dosificació de meropenem i piperacilelina en pacients amb xoc sèptic, IRA i requeriment de TCSR és encara molt complex. HIPÒTESI: La dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR és sub[òptima degut a les variacions en el comportament FC dels fàrmacs produïdes tant per la malaltia com pel maneig mèdic d’aquesta. Aquestes variacions FC poden comprometre l'assoliment de concentracions terapèutiques. OBJECTIUS: 1. Avaluar la idoneïtat de les recomanacions actuals sobre dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR; 2. Identificar les fonts de variabilitat que comprometen l’exposició òptima a aquests antibiòtics en la nostra població de pacients; i 3. Desenvolupar noves recomanacions per individualitzar la dosificació d’aquests antibiòtics tenint en compte aquestes fonts de variabilitat. METODOLOGIA: En base a la hipòtesi i els objectius, s’han desenvolupat els tres estudis següents: Estudi 1: Revisió de la literatura. S’ha realitzat una revisió sistemàtica i avaluació crítica de l'evidència disponible sobre la dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic, IRA i requeriment de TCSR. Estudis 2 i 3: Caracterització de la FC de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR. S’han realitzat dos estudis farmacocinètics multicèntrics, oberts, prospectius observacionals, a les Unitats de Medicina Intensiva de tres hospitals espanyols de tercer nivell. S’han inclòs a l’estudi 30 pacients amb xoc sèptic, IRA i TCSR que rebien meropenem i 19 pacients que rebien piperacilelina. Amb les dades procedents d’aquests pacients, s’han desenvolupat i validat dos models FC poblacionals, a partir dels quals s’han realitzat simulacions de Monte Carlo de diferents esquemes terapèutics (mitjançant el software NONMEM v.7.3®). RESULTATS: La principal troballa de l'estudi 1 és que les recomanacions actuals de dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR es basen en estudis amb algunes limitacions, com ara: 1) diferents nivells de gravetat de la malaltia i de disfunció renal, 2) diferents diagnòstics d’ingrés (mèdic versus quirúrgic versus trauma), 3) diferents maneigs clínics, principalment referent a les característiques de la TCSR, 4) metodologies heterogènies d’anàlisi FC, i 5) diferents objectius farmacodinàmics (FD) en base als quals es fan les recomanacions de dosificació. Això compromet l'extrapolació dels resultats d’aquests estudis a la nostra població de pacients. Posteriorment, els estudis 2 i 3 han identificat importants fonts de variabilitat en la FC de meropenem i piperacilelina, que si es consideren en el moment de la dosificació poden ser útils per individualitzar el tractament antibiòtic. Pel que fa a meropenem, la principal conclusió de l'anàlisi FC poblacional és la relació existent entre la diüresi acumulada de 24h i l’aclariment total de meropenem (CL). Els pacients amb diüresi conservada (>500ml/24h) presenten un increment d’almenys el 30% sobre el CL total de meropenem en comparació amb aquells pacients anúrics (<100mL/24h), sent aquest augment en el CL del fàrmac directament proporcional al volum d'orina. Posteriorment, les simulacions de Monte Carlo basades en aquest model FC poblacional han demostrat que per tal de mantenir les concentracions de meropenem per damunt de la concentració mínima inhibitòria (CMI) dels bacteris durant un 100% de l'interval de dosificació (100% FuT>CMI), els pacients oligo[anúrics (diüresi residual de 0[500mL/24h) requereixen 500mg/q8h administrats en un bolus de 30 minuts per al tractament de microorganismes susceptibles (CMI <2 mg/L), mentre que els pacients amb diüresi conservada (>500mL/24h) requereixen la mateixa dosi administrada mitjançant una perfusió de 3h. Pel tractament de microorganismes amb una CMI propera al límit de susceptibilitat (2[ 4mg/L) és necessària una dosi de 500mg/q6h: administrada en un bolus de 30 minuts de en pacients oligo[anúrics i mitjançant una perfusió de 3h en pacients amb una diüresi conservada. Si s’escull un objectiu FD més conservador, (40% FuT>CMI), una dosi de 500mg/q8h administrada en un bolus de 30 minuts és suficient amb independència de la diüresi residual. Pel que fa a la piperacilelina, la principal conclusió de l'anàlisi FC poblacional és la relació existent entre el tipus de membrana utilitzada per la TCSR, el pes del pacient i el CL total de piperacilelina; per a un pes de 80 kg, el CL total de piperacilelina es duplica quan es fa servir una membrana d’1,5m2 de copolímer d’acrilonitril i sulfat sòdic de metalelil amb un recobriment d’heparina i polietilenimina (AN69ST) en comparació amb el CL total observat quan es fa servir un filtre AN69 convencional de 0,9m2. Posteriors simulacions de Monte Carlo han demostrat que per a un objectiu FD de 100% FuT>CMI, els pacients que reben TCSR amb membranes AN69ST d’1,5m2 requereixen dosis de 4000mg/q8h per al tractament de microorganismes amb CMI properes al límit de susceptibilitat (CMI = 8[ 16mg/L). Per contra, 2000mg/q8h són suficients per als pacients que reben TCSR amb membranes AN69 de 0,9 m2. Per al tractament de soques d’alta susceptibilitat a la piperacilelina (CMI ≤ 4mg/L), o per l’assoliment d'un objectiu FD més conservador (50% FuT>CMI), 2000mg/q8h són suficients en tots els casos.
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Leusin, Fabiane. "Farmacocinética do Meropenem infundido por 3 horas em pacientes criticamente enfermos em terapia renal substitutiva contínua." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/48990.
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A terapia renal substitutiva contínua (TRSC) é amplamente utilizada em pacientes criticamente enfermos com insuficiência renal aguda (IRA). O meropenem é um carbapenêmico usado em pacientes críticos que tem uma atividade antibacteriana dependente do tempo. O objetivo do estudo foi avaliar a farmacocinética do meropenem infundido em três horas em pacientes submetidos à TRSC. Estudamos as concentrações plasmáticas e de efluente em cinco pacientes submetidos à TRSC. As amostras foram coletadas em momentos 0, 30 min, e 1, 2, 4, 6 e 8 horas após o início de uma infusão de 3 horas. As determinações de meropenem foram feitas por cromatografia líquida de alta eficiência. Quatro pacientes do sexo masculino e um feminino, idade de 53,0 ± 19,7 (23 a 80 anos), 62,1 ± 10,6 kg, foram estudados. Parâmetros farmacocinéticos apresentados em mediana (amplitude): concentrações plasmáticas, 34.86mg / L (10,08-139,27); tempo de meia vida (t ½), 1,8 h (1,4-3,0); volume de distribuição (Vd), 8,29 L (5,8-15,3); depuração total (Dept ) 3,98 L / h (2,51-4,35); concentração máxima (Cmax) 48,5 mg/L (37,0-105,8); concentração mínima (Cmin) 20,1 mg / L (14,0-16,6); constante de eliminação (Kel), 0,38 (0,34-0,43); área sob a curva de concentração versus tempo (AUC 0 a 8 h), 251,1 mg / Lh (229,7-398,4); (AUC de 0a∞), 275,1 mg /Lh (263,8-453,6).A depuração total pela TRSC variou de 8,46 a 18,33 ml/min. No efluente as concentrações máximas foram 24,35 e 74,81 mg /L. A eliminação de meropenem por TRSC é semelhante ao que é relatado pelo rim normal, quando é infundido por 3 horas a cada 8 h. Os níveis plasmáticos foram sempre acima do MIC necessário. Podemos concluir que não houve necessidade de ajuste de dose do meropenem com a dose de TRSC prescrita.Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute kidney injury (AKI). Meropenem is a carbapenem used in critically ill patients, which has a time dependent antibacterial activity. The aim of the study was to assess the pharmacokinetics of meropenem on a 3-hour infusion in patients undergoing CRRT due to AKI. We studied the plasmatic and effluent concentrations in five patients undergoing CRRT. The samples were collected at moments 0, 30 minutes, and 1, 2, 4, 6 and 8 hours after the beginning of the 3-hour infusion. The meropenem determinations were made through high performace efficiency liquid chromatography (HPLC). Four male patients and one female patient, with a mean age of 53,0 ± 19,7 (23 to 80 years), weighing 62,1 ± 10,6 kgs were studied. Pharmacokinetic parameters presented in medians (range): plasmatic concentrations, 34.86mg / L (10,08-139,27); half-life (t ½), 1,8 h (1,4-3,0); volume of distribution (Vd), 8,29 L (5,8-15,3); total clearance (CLT) 3,98 L / h (2,51-4,35); (Cmax) (maximum plasma concentration), 48,5 mg / L (37,0-105,8); Cmin (minimum plasma concentration)20,1 mg / L (14,0-16,6); elimination constant (Kel), 0,38 (0,34-0,43); area under the concentration versus time curve (AUC 0 a 8 h), 251,1 mg / Lh (229,7-398,4); (AUC 0 a ∞) 275,1 mg / Lh (263,8-453,6). In the effluent, the maximum concentrations varied from 24,35 to 74,81 mg/L, and the clearance from the therapy varied from 8,46 to 18,33 ml/min. The elimination of meropenem through CRRT is similar to that of a normal kidney, given a 3-hour infusion every 8 hours. Plasmatic levels were always above the necessary MICs. We can conclude there was no need for dose adjustment of meropenem with the prescribed CRRT dose.
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Sandri, Ana Maria. "Farmacocinetica da polimixina B intravenosa em pacientes em Unidade de Terapia Intensiva." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/88427.
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Foi realizado um estudo de farmacocinética da polimixina B em pacientes críticos com desenvolvimento de um modelo populacional. Os critérios de inclusão foram pacientes internados em Unidade de Terapia Intensiva, com idade igual ou superior a 18 anos e em uso de polimixina B intravenosa por um período mínimo de 48 horas. Amostras de sangue, urina e dialisato foram coletadas durante um intervalo de doses no estado de equilíbrio. A concentração de polimixina B no plasma foi medida por meio de cromatografia líquida de alta performance associada à espectrometria de massas acoplada à espectrometria de massas, sua ligação às proteínas plasmáticas foi determinada por meio de diálise de equilíbrio rápido e a fração livre foi calculada. Foram realizadas análise farmacocinética populacional e Simulações de Monte Carlo. Foram incluídos 24 pacientes, dos quais dois estavam em hemodiálise contínua; 54,2% eram do sexo masculino e as medianas da idade, do escore APACHE e do peso corporal total foram de 61,5 anos, 21,5 e 62,5kg, respectivamente. As doses de polimixina B, conforme prescrição do médico assistente, variaram entre 0,45-3,38mg/kg/dia. O clearance estimado da creatinina nos 22 pacientes sem hemodiálise variou entre 10-143mL/min. A mediana da fração livre plasmática da polimixina B foi de 0,42 e a média (± desvio padrão) da fração livre da área sob a curva ao longo de um dia (fAUC0-24h) da polimixina B foi de 29,2±12,0mg•h/L, incluindo os pacientes em hemodiálise. A polimixina B foi excretada predominantemente por vias não renais e as medianas de sua recuperação urinária de forma inalterada foi de 4,04% e do seu clearance renal foi de 0,061L/hora. Nos pacientes 1 e 2 em hemodiálise foram identificados, respectivamente, clearance corporal total de 0,043 e 0,027L/h/kg, clearance da hemodiálise de 0,0052 e 0,0015L/h/kg; no dialisato foram recuperados 12,2% e 5,62% da dose como polimixina B não modificada. O clearance corporal total da polimixina B não mostrou nenhuma relação com o clearance da creatinina, escore APACHE II ou idade. A disposição da polimixina B no tempo foi adequadamente descrita pelo modelo de dois compartimentos com eliminação linear. O modelo farmacocinético populacional proporcionou ajustes excelentes para os perfis observados de concentração-tempo para pacientes individuais e as concentrações individuais e populacionais ajustadas foram precisas. O ajuste dos clearances e dos volumes de distribuição para o peso corporal total reduziu a variabilidade intersujeitos em 3,4% para o clearance e 41,7% para o volume de distribuição central; nos pacientes em diálise, após esse ajuste, os parâmetros estimados se assemelharam aos dos demais pacientes. As Simulações de Monte Carlo foram feitas com seis diferentes regimes de doses clinicamente relevantes escalonados pelo peso corporal total. O regime de doses de 1,5mg/kg 12/12h forneceu uma AUC0-24h de polimixina B no dia 4 de 90.4mg•hora/L para 50% dos pacientes, adequada para erradicação bacteriana em infecções graves por Pseudomonas aeruginosa ou Acinetobacter baumannii com concentração inibitória mínima para a polimixina B ≤2mg/L. Nas Simulações de Monte Carlo também foi possível identificar que uma melhor área sob a curva só foi atingida no dia 4 de tratamento. Este estudo mostrou que a dose de polimixina B intravenosa deve ser ajustada ao peso corporal total, que o melhor regime de doses é o de 1,5mg/kg 12/12h precedido de dose de ataque de 2,5mg/kg e que não há indicação de ajuste para a função renal, mesmo em pacientes em hemodiálise contínua.A polymyxin B pharmacokinetics study in critically ill patients was conducted with the development of a population modeling. The inclusion criteria were patients from Intensive Care Unit, aged ≥18 years who received intravenous polymyxin B for ≥ 48 hours. Blood, urine and dialysate samples were collected over a dosing interval at steady state. Polymyxin B concentrations was measured by liquid chromatography- tandem mass spectrometry, its plasma protein binding was determined by rapid equilibrium dialysis and unbound fraction was calculated. Population pharmacokinetic analysis and Monte Carlo Simulations were conducted. Twenty four patients were enrolled, two of whom on continuous hemodialysis; 54.2% were male; the median of age, APACHE II score and total body weight were 61.5years, 21.5 and 62.5kg, respectively. The physician-selected dose of polymyxin B was 0.45- 3.38mg/kg/day. The creatinine clearance of the 22 patients without hemodialysis ranged from 10 to 143mL/min. The median unbound fraction in plasma of polymyxin B was 0.42 and the mean (± standard deviation) of the area under the curve over a day for unbound (fAUC0-24h) polymyxin B was 29.2±12.0mg•hour/L, including hemodialysis patients. Polymyxin B was predominantly nonrenally cleared with median unchanged urinary recovered of 4.04%; the median renal clearance was 0.061L/hour. Patients 1 and 2 in hemodialysis presented, respectively, total body clearance of 0.043 and 0.027L/h/kg, hemodialysis clearance of 0.0052 and 0.0015L/h/kg; 12.2% and 5.62% of the polymyxin dose were recovered intact in the dialysate. Polymyxin B total body clearance did not show any relationship with creatinine clearance, APACHE II score, or age. The time course of polymyxin B concentrations was well described by a 2-compartment disposition model with linear elimination. The population pharmacokinetics model provided excellent fits to the observed concentration-time profiles for individual patients and the individual-fitted and population-fitted concentrations were adequately precise. Linear scaling of clearances and volumes of distribution by total body weight reduced the between subject variability in 3.4% for clearance and 41.7% for the central volume of distribution; after this scaling, the estimated parameters in hemodialysis patients were within the range of estimates from the other patients. The population mean of the total body clearance of polymyxin B when scaled by total body weight (0.0276L/hour/kg) showed remarkably low interindividual variability. The Monte Carlo Simulations were performed for six different clinically relevant dosage regimens scaled by total body weight. The regimen of 1.5mg/kg/12 hours provided an AUC0- 24h of polymyxin B of 90.4 mg•h/L in day 4 for 50% of patients which is appropriate considering severe infections by Pseudomonas aeruginosa or Acinetobacter baumannii with minimal inhibitory concentration for polymyxin B ≤2mg/L. In Monte Carlo Simulations we also identified that the best area under the curve was attained only in the day 4 of the treatment. This study showed that doses of intravenous polymyxin B are best scaled by total body weight, that the best regimen of doses is 3mg/kg/day with a loading dose of 2.5mg/kg and that its dosage selection should not be based on renal function, even in patients in continuous hemodialysis.
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Parentin, Torsten. "Kontinuierliche Nierenersatztherapie mit regionaler Citrat-Antikoagulation bei Schwerbrandverletzten." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-114384.
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Hintergrund: Die regionale Citrat-Antikoagulation im Rahmen der Nierenersatztherapie hat bei interdisziplinären Intensivpatienten in den letzten Jahren zunehmend an Bedeutung gewonnen. Für Schwerbrandverletzte existieren bislang kaum Untersuchungen zu diesem Verfahren. Ziel dieser Arbeit war es, die kontinuierliche Nierenersatztherapie mit Citrat-Antikoagulation bei Intensivpatienten mit akutem Nierenversagen nach schwerem Verbrennungstrauma im Hinblick auf Praktikabilität, Effektivität und Komplikationshäufigkeit sowie die Stabilität von Elektrolyt- und Säure-Basen-Haushalt und Gerinnung zu untersuchen. Daneben sollten Aussagen zur Prävalenz des akuten Nierenversagens in dieser Patientengruppe und zu dessen Einfluss auf die Letalität getroffen werden.
Methode: Im Rahmen einer retrospektiven Untersuchung wurden unter Verwendung von Patientenakten und Patientendatenmanagementsystem (PDMS) Daten von 27 Schwerbrandverletzten (VKOF ≥ 20% oder ABSI ≥ 8) mit akutem Nierenversagen ausgewertet, die zwischen Januar 2004 und Dezember 2009 im Verbrennungszentrum des Klinikums Sankt Georg Leipzig mit einer kontinuierlichen Nierenersatztherapie behandelt wurden. Bei allen Patienten kam ein Dialysegerät Prisma CFM (Gambro Hospal GmbH, Deutschland) mit einer Polyacrylnitril-Filtermembran (AN 69, Filterset M 100) der gleichen Firma zum Einsatz. Standardverfahren war eine kontinuierliche veno-venöse Hämodiafiltration (CVVHDF) im Prädilutionsmodus.
Bei 18 Patienten wurde eine regionale Citrat-Antikoagulation als Antikoagulationsverfahren eingesetzt, bei 7 Patienten eine systemische Heparin-Antikoagulation, bei 2 Patienten kamen alternierend beide Verfahren zum Einsatz. Für die 18 Patienten unter regionaler Citrat-Antikoagulation erfolgte eine detaillierte Analyse des akuten Nierenversagens unter Einbeziehung des klinischen Verlaufes, der Laborparameter und der Behandlungsdaten des Nierenersatzverfahrens.
Ergebnisse: Die Prävalenz eines akuten Nierenversagens mit Notwendigkeit zur Nierenersatztherapie bei Schwerbrandverletzten betrug 15,5%. Die Sterblichkeitsrate war in der Patientengruppe mit Nierenversagen etwa fünffach erhöht (25,9 vs. 4,8%). Die Letalitätsrate bei den Patienten unter systemischer Heparin-Antikoagulation war bei vergleichbarem Verbrennungsausmaß etwa fünfmal höher als unter regionaler Citrat-Antikoagulation (57,1 vs. 11.1%). Die Nierenersatztherapie wurde im Median nach 6 Tagen begonnen, die mediane Behandlungsdauer pro Patient betrug 7 Tage. Bei Start der CVVHDF wiesen 94,4% der Patienten einen Schockzustand mit Notwendigkeit einer Vasopressortherapie auf, 83,3% zeigten schwere Dysfunktionen in mindestens 3 Organsystemen, der SOFA-score lag im Median bei 14. Bei einer mittleren Citratkonzentration von 3,6 mmol/l Blut im Extrakorporalkreiskauf konnte eine mediane effektive Filterlaufzeit von 67 Stunden erreicht werden. Hypocalcämien (<0,9 mmol/l) fanden sich in 1,1%, Hypercalcämien (>1,3 mmol/l) in 0,4%. Hypernatriämien (<150 mmol) waren mit 0,4% ebenso selten wie metabolische Alkalosen (pH >7,50 und BE >4) mit 0,2%. Im Gesamtdialysezeitraum von 3790 Stunden gab es nur ein Blutungsereignis, die Gerinnungsparameter zeigten bis auf einen passageren Abfall der Thrombozytenzahl keine signifikanten Veränderungen. Die erzielte mittlere Dialysedosis war mit 35,1 ml/kg Körpergewicht/h ausreichend hoch. Neben einer Reduktion der Nierenretentionsparameter Serum-Creatinin und Serum-Harnstoff fanden sich unter dem Nierenersatzverfahren verbesserte Oxygenierungsindices und sinkende SOFA-scores. Keiner der überlebenden Patienten war zum Zeitpunkt der Entlassung dialysepflichtig.
Zusammenfassung: Die CVVHDF unter regionaler Citrat-Antikoagulation ist bei Schwerbrandverletzten ein effektives und in Bezug auf Säure-Basen-Haushalt, Elektrolyte und Gerinnung sicheres Verfahren. Neben einer effektiven Elimination harnpflichtiger Substanzen konnten eine exzellente Stabilität von Elektrolyten und metabolischen Parametern sowie eine suffiziente Antikoagulation im Extrakorporalkreislauf mit niedrigem Blutungsrisiko und konstant langen Filterlaufzeiten nachgewiesen werden. Die Prävalenz des akuten Nierenversagens bei Schwerbrandverletzten ist hoch, die Letalität bei Vorliegen des Organversagens vier-bis fünffach erhöht.
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Pokorná, Lenka. "Ošetřovatelské postupy u komplikované peritonitis." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-404851.
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(v AJ) For my diploma thesis I chose Nursing care for patients with complicated peritonitis as a topic, because care for these patients must be complex and often requires long-term stay at the anesthesiology and resuscitation department. These patients require organ support, undergo repeated surgical revisions, and ultimately, if they overcome this critical period, they learn very often self- care, walking, and sometimes adapt to permanent changes in health. It is a disease where there are often sudden changes in the patient's condition. In the theoretical part I tried to describe the disease leading to the development of peritonitis and complications in the form of septic shock and multiorgan failure. In the National Medical Library, I have searched for a comprehensive review of literature since 2005. I searched for keywords and phrases: Peritonitis, Nursing Care, Sepsis, Multiorgan Failure, Circulatory Support, Artificial Pulmonary Ventilation, Continuous Function Replacement kidney care, laparotomy care, drainage care, intra-abdominal hypertension. I obtained other documents using the central search engine UKAŽ, I drew from licensed databases: Bibliographia medica Čechoslovaca, Ebsco, Medline, Pubmed. For the processing of nursing procedures I used the recommendations of professional societies:...
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Huang, Yi-Chen, and 黃意媜. "The effectiveness of self-learning manual on nursing staffs learning continuous renal replacement therapy." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/68524754859372447115.
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碩士國立台北護理學院
醫護教育研究所
98
The purpose of this quasi-experimental research was to explore the learning effectiveness of the knowledge, technique and learning satisfaction within nursing staffs after the intervention of continuous renal replacement therapy(CRRT) self-learning manual. Sixty-six nurses were enrolled from intenstive care units of Taipei medical hospital. Thirty-four nurse in the experimental group accepted 2 weeks CRRT self-learning manual. Thirty-two nurses in the control group did not. The cohors in both groups adopted before and after introducing intervention manual. Data was analyzed by SPSS17.0 software package with deductive statistics,frequency distribution, percentage, mean value, standard deviation, t-test and paried t-test. The results showed that experimental group scored significantly better in the test of knowledge, technique and learning statisfaction to CRRT self-learning manual than control group after intervention. In addition, the experimental group had significant differences in the test of knowledge and technique to CRRT self-learning manual compared with pre-intervention. In the future, the strategy of self-learning manual could be applied to continous education for intensive care unit nursing staffs extensively to increase the learning effectiveness as well as to improve the quality of nursing care. Morover, we could also increase the population in study and follow the outcome of patients, evaluation effectiveness of the quality of nursing care.
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Chan, Shih-Yi, and 詹十宜. "Related factors of the prognosis in patients with first time receiving continuous renal replacement therapy at surgical intensive care unit." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/96362890093177054971.
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碩士國立臺灣大學
護理學研究所
103
Background: Acute renal injury/failure was a common complication among patients who admitted to surgical intensive care unit (SICU). The incidence rate was 20% to 67% and mortality rate was 26%. There was a huge medical cost and spending for follow-up health care. The study focused at related factors and prognosis of SICU patients who first-time receiving continuous renal replacement therapy (CRRT). Objective: To understand the incidence and prognosis of acute renal injury/failure; to understand the characteristics of demographic and disease in patients with CRRT; to analyze the relation between clinical situation and prognosis in patients with CRRT; to explore the related factors of prognosis in patients with CRRT. Method: This study was a retrospective and descriptive correlational design in which data were retrieved from medical charts of patients who first-time receiving CRRT at a medical center SICU in central Taiwan. Data was collected from January 1st, 2012 to December 31st, 2013 by using a self-designed chart-record sheet. The data was analyzed by descriptive statistics and inferential statistics. Results: The incidence rate of CRRT was 6.4% and 251cases were recruited. When the subjects discharged from SICU after 1-73days staying, there were 118 survivals and the mortality rate was 53％. Among survivals, becoming hemodialysis-depended patients were 27 (23％) and the others (77%) were free from dialysis therapy. Male, age≧70 years old and gastro-intestinal surgical patients, they had higher risk to acute renal injury/failure. Comparing the two groups (survivals vs. deaths) in the serum creatinine at SICU admitted (3.2 vs. 2.1 mg/dL), the percentage of belonging RIF levels in RIFLE criteria (80% vs. 51%), the interval of SICU admitted to on-CRRT (4.8 vs. 6.7 days), the serum creatinine at pre on-CRRT (3.7 vs. 2.9 mg/dL), the percentage of non-shock (33% vs. 20%), the percentage of non-using mechanical ventilator (15% vs. 5%). The results showed significant differences between the two groups. The abnormal serum creatinine while admitted to SICU, the interval of SICU admitted to on-CRRT ≦2 days and no mechanical ventilator using at pre on-CRRT, they had higher survival rate. Conclusion: The study found that elder male patients and APACHEⅡscore≧20 had higher risk to acute renal injury/failure. Evaluating patients comprehensively and implementing CRRT at the right moment were important in clinical practice, and then allowed survivors have a higher chance of recovering renal function.
Books on the topic "Continuous renal replacement therapy (CRRT)"
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P, Paganini Emil, ed. Acute continuous renal replacement therapy. Boston: M. Nijhoff, 1986.
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Paganini, Emil P., ed. Acute Continuous Renal Replacement Therapy. Boston, MA: Springer US, 1986. http://dx.doi.org/10.1007/978-1-4613-2311-2.
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Assadi, Farahnak, and Fatemeh Ghane Sharbaf. Pediatric Continuous Renal Replacement Therapy. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-26202-4.
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Schetz, Miet, and Andrew Davenport. Continuous renal replacement therapy. Edited by Norbert Lameire. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0234.
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After its introduction, continuous renal replacement therapy (CRRT) has found widespread acceptance amongst physicians taking care of critically ill patients. Various modalities (haemofiltration, haemodialysis, haemodiafiltration) are used. As for all types of renal replacement therapy, a good functioning vascular access is an absolute requirement. Whether CRRT is to be preferred over intermittent haemodialysis remains a matter of debate, but haemodynamic instability and risk of cerebral oedema are generally considered indications for CRRT. Whereas under-dosing should certainly be avoided, increasing the dose over an actually delivered effluent flow of 20–25 mL/kg/hour does not appear to improve outcome.One of the major drawbacks of CRRT is the requirement for continuous anticoagulation. Citrate anticoagulation is gaining popularity and represents a valuable alternative, especially in patients with bleeding risk. Other potential complications of CRRT include thermal, nutrient, and drug losses, and acid–base and electrolyte disturbances.
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Schneider, Antoine G., Neil J. Glassford, and Rinaldo Bellomo. Choice of Renal Replacement Therapy and Renal Recovery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0038.
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Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events have been associated with fresh renal injury. In contrast, continuous renal replacement therapy (CRRT) does not carry such risks. Consistent with such physiological and experimental observations and differences, several observational studies and some randomized controlled trials suggest that using IHD, instead of CRRT, as the preferred form of RRT increases the risk of patients entering a chronic dialysis programme. A recent meta-analysis confirmed these findings. Clinicians making decisions about the choice of RRT modality in ICU patients should carefully consider these observations.
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Ricci, Zaccaria, and Claudio Ronco. Continuous haemofiltration techniques in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0214.
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Continuous renal replacement therapy (CRRT) is currently considered the mainstay of treatment for severe acute kidney injury. CRRT helps in restoration of fluid balance, control of hyperazotaemia, acid-base imbalances, and electrolyte abnormalities. Most importantly, due to its gradual, low efficiency, continuous solute and water removal, it ensures haemodynamic stability in critically-ill patients being treated with a high level of inotropic support and those with cardiovascular failure. This chapter will discuss the different solute removal techniques (diffusion and convection) and CRRT modalities (ultrafiltration, haemofiltration and haemodialysis). Insights on CRRT prescription and anticoagulation regimens will also be described on the light of the most recent clinical evidence.
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Ronco, Claudio, Rinaldo Bellomo, and John A. Kellum. Continuous Renal Replacement Therapy. Oxford University Press, Incorporated, 2016.
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A, Kellum John, Bellomo R. 1956-, and Ronco C. 1951-, eds. Continuous renal replacement therapy. Oxford: Oxford University Press, 2009.
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Kellum, John A., Rinaldo Bellomo, and Claudio Ronco, eds. Continuous Renal Replacement Therapy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190225537.001.0001.
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Kellum, John A. Continuous Renal Replacement Therapy. Oxford University Press, 2009.
Find full textBook chapters on the topic "Continuous renal replacement therapy (CRRT)"
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Assadi, Farahnak, and Fatemeh Ghane Sharbaf. "CRRT Prescription." In Pediatric Continuous Renal Replacement Therapy, 71–97. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-26202-4_4.
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Assadi, Farahnak, and Fatemeh Ghane Sharbaf. "Pharmacokinetics of CRRT." In Pediatric Continuous Renal Replacement Therapy, 99–120. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-26202-4_5.
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Assadi, Farahnak, and Fatemeh Ghane Sharbaf. "Continuous Renal Replacement Therapy (CRRT)." In Pediatric Continuous Renal Replacement Therapy, 41–70. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-26202-4_3.
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Abbasi, Adeel, Francis DeRoos, José Artur Paiva, J. M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, et al. "Continuous Renal Replacement Therapy (CRRT)." In Encyclopedia of Intensive Care Medicine, 603. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-00418-6_1395.
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Cerdá, Jorge, Ashita Tolwani, Shamik Shah, and Claudio Ronco. "Continuous Renal Replacement Therapy (CRRT)." In Studies in Computational Intelligence, 929–1009. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-27558-6_4.
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Harms, James, Keith Wille, and Ashita Tolwani. "Complications of Continuous Renal Replacement Therapy (CRRT)." In Core Concepts in Dialysis and Continuous Therapies, 211–19. Boston, MA: Springer US, 2016. http://dx.doi.org/10.1007/978-1-4899-7657-4_17.
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Bunchman, Timothy E. "Anticoagulation and Continuous Renal Replacement Therapy (CRRT)." In Pediatric Dialysis Case Studies, 287–92. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-55147-0_38.
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Gallagher, Helen C., and Patrick T. Murray. "Drug Dosing in Continuous Renal Replacement Therapy (CRRT)." In Core Concepts in Dialysis and Continuous Therapies, 231–41. Boston, MA: Springer US, 2016. http://dx.doi.org/10.1007/978-1-4899-7657-4_19.
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Askenazi, David J. "Continuous Renal Replacement Therapy (CRRT) for a Neonate." In Pediatric Dialysis Case Studies, 279–85. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-55147-0_37.
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Tulli, Giorgio. "Antibiotic Dosing During Continuous Renal Replacement Therapy (CRRT)." In Topical Issues in Anesthesia and Intensive Care, 1–33. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-31398-6_1.
Full textConference papers on the topic "Continuous renal replacement therapy (CRRT)"
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Santhanakrishnan, Arvind, Trent Nestle, Brian Moore, Ajit P. Yoganathan, and Matthew L. Paden. "Characterization of a Low Extracorporeal Volume, High Accuracy Pediatric Continuous Renal Replacement Therapy Device." In ASME 2012 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/sbc2012-80210.
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The incidence of acute kidney injury (AKI) is commonly seen in critically ill children, the origins of which may be traced to a wide range of conditions such as inborn errors of metabolism, sepsis, congenital heart defects, bone marrow and organ transplantation, and to a lesser extent from multiple organ dysfunction syndrome (MODS) [1]. It is vital to provide a form of fluid and electrolyte clearance in these patients until native renal function improves. Nearly 3,600 critically ill children per year with acute kidney injury receive life-saving continuous renal replacement therapy (CRRT) in the United States. However, there is no CRRT device approved by the Food and Drug Administration for use in pediatric patients. Thus, clinicians unsafely adapt adult CRRT devices for use in the pediatric patients due to lack of safer alternatives. Complications observed with using adult adapted CRRT devices in children include hypotension, hemorrhage, thrombosis, temperature instability, inaccurate fluid balance between ultrafiltrate (UF) removed from and replacement fluid (RF) delivered to the patient, electrolyte disorders, and alteration of drug clearance. This research addresses this unmet clinical need through the design, mechanical and biological characterization of a pediatric specific Kidney Injury and Dysfunction Support (KIDS) CRRT device that provides high accuracy in fluid balance, reduces extracorporeal blood volume, and eliminates other problems associated with using adapted adult CRRT devices in children.
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Laksman, ZW, TE Stewart, D. Hallett, and S. Mehta. "HFOV Settings and Gas Exchange in Adults with ARDS Receiving Continuous Renal Replacement Therapy (CRRT)." In American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California. American Thoracic Society, 2009. http://dx.doi.org/10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a3095.
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Liao, H. I., and K. A. Radigan. "Early Use of Continuous Renal Replacement Therapy (CRRT) for Septic Shock in an End-Stage Renal Disease (ESRD) Patient." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a1716.
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Kong, Ning, Xiaoxi Liu, Chunyan Liu, Jie Lian, and Hongwei Wang. "Deep architecture for Heparin dosage prediction during continuous renal replacement therapy." In 2017 36th Chinese Control Conference (CCC). IEEE, 2017. http://dx.doi.org/10.23919/chicc.2017.8029139.
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Rodriguez, W., M. Mercader-Perez, G. L. Marin-Garcia, and F. Merced. "Severe Hypothermia Secondary to Adrenal Insufficiency Treated with Continuous Renal Replacement Therapy." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a5154.
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Donthi, S., R. C. Albright, K. Shawwa, S. Tehranian, E. F. Barreto, and K. Kashani. "Saving Cost Using Individualized Medicine: A Pilot Project for Continuous Renal Replacement Therapy." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4125.
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ALenezi, Farhan Z. "Continuous Renal Replacement Therapy Comparing Continuous Venovenous Hemofiltration (CVVH) Vs Continuous Venovenous Hemodifiltration(CVVHDF) In Reducing Mortality In The Intensive Care Units." In American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California. American Thoracic Society, 2012. http://dx.doi.org/10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3147.
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Mayer, K., A. R. Hornsby, J. T. Cunningham, H. Yuan, C. Hauschild, P. E. Morris, and J. A. Neyra. "Early Rehabilitation in Patients Requiring Continuous Renal Replacement Therapy Is Safe and Feasible: A Quality Improvement Initiative." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4108.
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Lian, Jie, and Qiao-Feng Zhao. "Prediction of Heparin Dose during Continuous Renal Replacement Therapy Surgery by Using the Gradient Boosting Regression Model." In 2019 6th International Conference on Control, Decision and Information Technologies (CoDIT). IEEE, 2019. http://dx.doi.org/10.1109/codit.2019.8820648.
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Leistner, M., S. Asch, K. Ort, A. Waghefi, B. Danner, H. Baraki, I. Kutschka, and H. Niehaus. "Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Critically Ill Patients after Cardiac Surgery—A safe Option?" In 48th Annual Meeting German Society for Thoracic, Cardiac, and Vascular Surgery. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1678853.
Full textReports on the topic "Continuous renal replacement therapy (CRRT)"
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Li, Yu, Jiaxing Feng, Bo Xu, Xiaoqi Deng, Yulei Chen, Ying Zhan, Liangchen Lv, Qing Ye, Xiaodan Guo, and Tianjun Guan. Predictors for short-term successful weaning from continuous renal replacement therapy: a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, August 2021. http://dx.doi.org/10.37766/inplasy2021.8.0082.
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