ICU中的血液净化指南之我见VIP免费

ICU中的血液净化指南之我见ICU中的血液净化指南之我见第一页，共四十二页。ContentsIntroduction1Typeoftherapy2TimingofCRRT3DoseofCRRT4Conclusions56第二页，共四十二页。IntroductionMethodsofextracorporealrenalreplacementtherapy(RRT)havebeenusedforthesupportivetreatmentofAKIforover60years.CRRTforthecriticallyillpatientwithARFwasintroducedin1977byKrameretal.Sincethen,manystudieshavereportedonCRRTinthecriticallyill.KlinWochenschr1977;55:1121-1122.第三页，共四十二页。IntroductionButforseveralreasonscomparisonamongstudiesisdifficult:Varioustreatmentmodalitieshavebeenappliedinheterogeneouspopulations.DifferencesinclinicalsettingandunderlyingmolecularbiologicalmechanismsthatinitiateandmaintainARF.Furthermore,morethan35definitionsofARF.Practicepatternsvarywidelybetweenindividualcenters.Uptonow,therearenostandardguidelinesfortheapplicationofCRRTincriticallyillpatients.CurrOpinCritCare2002;8:509-514.第四页，共四十二页。IntroductionTheRIFLEClassificationforacuterenalfailureCritCare2004;8:R204-R212.第五页，共四十二页。IntroductionConclusions:Morethen200differentdefinitionsofARFandabout90RRTstartcriteriawerereported.OliguriaandRIFLEwerethemostfrequentcriteriausedtodefineARF.RIFLEcriteriamightshowaclinicalimpactonfuturedailypracticeandresearch.DifferentRRTtechniquesareavailableinmostcenters,butagenerallackoftreatmentdosestandardizationisnotedbyoursurvey.Non-renalindicationstoRRTstillneedtofindadefinitiveroleinroutinepractice.NephrolDialTransplant(2006)21:690–696第六页，共四十二页。Inthepast,theinteractionbetweennephrologyandintensivecarewasminimal.Today,thereiscontinuousinteractionwithseveralmomentsofhighinteractionduetocommonpatientsandcomplexsyndromes,andmuchofthetreatmentofAKIhasmovedfromtherenalwardintoICUs.IntroductionContribNephrol.Basel,Karger,2022(166):1–3第七页，共四十二页。ContentsIntroduction1Typeoftherapy2TimingofCRRT3DoseorintensityofCRRT4Conclusions56第八页，共四十二页。TypeoftherapyClassificationofbloodpurificationincriticalcare(BPCC)technologyPMX=polymyxin-Bimmobilizedfiber;PMMA=polymethylmethacrylate;PAN=polyacrylonitrile;PEPA=polyetherpolymeralloyContribNephrol.Basel,Karger,2022(166):11–20第九页，共四十二页。TypeoftherapyAsacontinuoustherapy,CRRTcanberapidlytailoredtochangesinapatient’sclinicalconditionduringcriticalillnessBloodpurificationincriticalcareContribNephrol.Basel,Karger,2022(166):11–20HDF=hemodiafiltration第十页，共四十二页。TypeoftherapyTheseadvantageshavecontributedtothewidespreaduptakeofCRRTasthefirst-choiceRRTinICUsthroughoutAustralia,JapanandEurope.Intheseregions,CRRTisusuallyinitiatedandmanagedwithintheICU,withRRTbeingintegratedwithotheraspectsofthemanagementofcriticalillnessNat.Rev.Nephrol.2022:6:521–529.第十一页，共四十二页。TypeoftherapyInnorthAmerica,however,traditionalstructuresofICUmanagementfavoran‘open-ICU’approach:Withinthismodel,RRTisusuallyprescribedbyanephrologistintheICUandisinitiatedbyadialysisnurseInthisenvironment,IHDhastheadvantageofrequiringonlydailyoralternate-dayattendancebytherenalteamConversely,therelativelaborcostsofprovidingCRRTareincreased,aneffectthatiscompoundedbythelargerfixedcostsandhigherconsumablerequirementsofCRRTTheselogisticfactorshaveledtoapreferenceforIHDoverCRRTbeingmaintainedinICUsthatusethenorthAmerican.Nat.Rev.Nephrol.2022:6:521–529.第十二页，共四十二页。Typeof...