Continuous Renal-Replacement Therapy for Acute Kidney Injury
نویسنده
چکیده
Copyright © 2012 Massachusetts Medical Society. Acute limb ischemia due to a perioperative type B (distal) thoracic aortic dissection develops in a 90-kg, 20-year-old man with Marfan’s syndrome who is admitted to the hospital for elective aortic-valve replacement. On postoperative day 1, he undergoes endovascular repair of the thoracic aorta. On postoperative day 4, his urine output decreases to 420 ml over a 24-hour period. He requires mechanical ventilation with a fraction of inspired oxygen (FiO2) of 0.70; his mean arterial pressure is 74 mm Hg with vasopressor support. He has had a positive fluid balance of 9.8 liters since admission. The serum creatinine level has increased from a baseline of 0.6 mg per deciliter (53.0 μmol per liter) to 4.4 mg per deciliter (389.0 μmol per liter). The bicarbonate level is 19 mmol per liter despite bicarbonate infusion, and the potassium level is 6.1 mmol per liter. The creatine kinase level has increased to 129,040 U per liter. An intensive care specialist evaluates the patient and recommends initiation of continuous renal-replacement therapy.
منابع مشابه
Renal replacement therapy in support of combat operations.
BACKGROUND Renal replacement therapy has been used by the U.S. Army at the combat support hospital echelon of care since the Korean conflict. Although there has been a general decline in the incidence of wartime acute kidney injury, the mortality associated with acute kidney injury and the use of renal replacement therapy remain unchanged, in the range of 60% to 80%. The U.S. Army official doct...
متن کاملTiming of continuous renal replacement therapy and mortality in critically ill children*.
OBJECTIVES Acute kidney injury and fluid overload frequently necessitate initiation of continuous renal replacement therapy in critically ill patients admitted to the ICU. In this study, our primary objective was to determine the effect of timing of initiation of continuous renal replacement therapy on ICU mortality in children requiring renal support for management of acute kidney injury and/o...
متن کاملRole of Technology for the Management of AKI in Critically Ill Patients: From Adoptive Technology to Precision Continuous Renal Replacement Therapy
This paper reports on the continuous renal replacement therapy (CRRT) technology group recommendations and research proposals developed during the 17th Acute Dialysis Quality Initiative Meeting in Asiago, Italy. The group was tasked to address questions related to the impact of technology on acute kidney injury management. We discuss technological aspects of the decision to initiate CRRT and th...
متن کاملRenal recovery after acute kidney injury: choice of initial renal replacement therapy modality still matters
Renal replacement therapy can be applied either in an intermittent fashion or in a continuous fashion in severe acute kidney injury. To date, no modality has been shown to consistently improve patient survival. In the study recently reported by Sun and colleagues, continuous application of renal replacement therapy was associated with improved renal recovery, defined by lower risk of long-term ...
متن کاملRenal replacement therapy for acute kidney injury.
The treatment of established acute kidney injury (AKI) is largely supportive in nature. Renal replacement therapy remains the cornerstone of management for the minority of patients who have severe AKI. Optimization of renal replacement therapy may modulate the high mortality associated with AKI. Recent trials indicated that continuous renal replacement therapy does not confer a survival advanta...
متن کاملPrinciples of antibacterial dosing in continuous renal replacement therapy.
BACKGROUND Appropriate antibacterial therapy is important to maximize patient survival in sepsis. Acute renal failure complicates optimal antibiotic administration. METHODS MEDLINE search from 1986 to 2010 using the terms 'acute renal failure', 'pharmacokinetics', 'clearance', 'dosage', 'h(a)emofiltration', 'h(a)emodialysis', 'h(a)emodiafiltration', 'continuous renal replacement therapy', 'an...
متن کامل