PDA

View Full Version : Liệu pháp thay thế thận liên tục - Continuous Renal Replacement Therapy (CRRT)



Ways
13-01-11, 07:00 PM
http://www.renalgate.it/crrt_prisma.jpg

http://thietbiytethuthuy.com.vn/admin/uploads/57340-Prismaflex_Product_240x380.jpg<<<<<<<<< PRISMAFLEX
CRRT is a mode of renal replacement therapy for hemodynamically unstable, fluid overloaded patients and patients with sepsis and septic shock inmanagement of acute renal failure especially in the intensive careunit setting.
Both intermittent hemodialysis and continuous hemodialysis circuits utilize the same principles. Blood is removed from the patient, pumped through a dialysis filter and returned to the patient following removal of surplus water and wastes. The filter performs many of the functions of the kidney's nephron unit, hence, it is referred to as an “artificial kidney”.
The major difference between intermittent and continuous therapies is the speed at which water and wastes are removed. Intermittent hemodialysis removes large amounts of water and wastes in a short period of time (usually over 2-4 hours), whereas, continuous renal replacement therapies remove water and wastes at a slow and steady rate.
Advantages Of CRRT
1. CRRT by its lower rate of fluid removal can lead to steady state fluid equilibrium in hemodynamically unstable, critically ill patients with associated comorbid conditions eg. M.I, ARDS, septicemia, bleeding disorders.
2. It provides excellent control of azotemia, electrolytes and acid base balance.
3. It is efficacious in removing fluid in special circumstances – post surgery pulmonary edema; ARDS etc.
4. CRRT can help in administration of parenteral nutrition and obligatory I.V medications like pressors & inotropes by creating an unlimited space by virtue of Continuous ultrafiltration.
5. Hemofiltration modality is effective in lowering intracranial tension v/s routine intermittent hemodialysis which can sometimes raise intracranial tension.
6. Proinflammtory mediators of inflammation are also shown to have been removed by this modality.
Disadvantages
This mode of therapy requires regular monitoring of hemodynamic status and fluid balance (ultrafiltration rate, replacement fluid); regular infusion of dialysate; continuous anticoagulation; ongoing alarms and an expensive mode of therapy above all.
INDICATIONS OF CRRT
a. RENAL CAUSES
1. ARF with cardiovascular instability
2. ARF with septicemia
3. ARF with septicemia and ARDS.
4. ARF with cerebral edema
b. NONRENAL CAUSES
1. Systemic inflammatory response syndrome
2. Crush syndrome
3. Lactic acidosis
4. C.H.F

Reference:
http://www.ispub.com/journal/the_internet_journal_of_anesthesiology/volume_21_number_1/article/continuous-renal-replacement-therapy-crrt.html