Fluid Management on Continuous Renal Replacement Therapy

2018 ◽  
pp. 60-69
Author(s):  
Raghavan Murugan ◽  
John A. Kellum
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Management

scholarly journals Development of an Accurate Fluid Management System for a Pediatric Continuous Renal Replacement Therapy Device

ASAIO Journal ◽  
2013 ◽  
Vol 59 (3) ◽  
pp. 294-301 ◽  
Author(s):  
Arvind Santhanakrishnan ◽  
Trent T. Nestle ◽  
Brian L. Moore ◽  
Ajit P. Yoganathan ◽  
Matthew L. Paden
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Management System ◽  
Fluid Management

scholarly journals How to prescribe and troubleshoot continuous renal replacement therapy: A case-based review

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0004912020
Author(s):  
Javier A. Neyra ◽  
Lenar Yessayan ◽  
Melissa L. Thompson Bastin ◽  
Keith Wille ◽  
Ashita J Tolwani
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Status ◽  
Fluid Management ◽  
Volume Control ◽  
Regional Citrate Anticoagulation ◽  
Case Based

Continuous renal replacement therapy (CRRT) is the preferred dialysis modality for solute management, acid-base stability, and volume control in critically ill patients with acute kidney injury (AKI) in the intensive care unit (ICU). CRRT offers multiple advantages over conventional hemodialysis in the critically ill population such as greater hemodynamic stability, better fluid management, greater solute control, lower bleeding risk and a more continuous (physiologic) approach of kidney support. Despite its frequent use, several aspects of CRRT delivery are still not fully standardized or do not have solid evidence-based foundations. In this manuscript, we provide a case-based review and recommendations of common scenarios and interventions encountered during the provision of CRRT to critically ill patients. Specific focus is made on initial prescription, CRRT dosing, and adjustments related to severe hyponatremia management, concomitant extracorporeal membrane oxygenation support, dialysis catheter placement, use of regional citrate anticoagulation and antibiotic dosing. This case-driven simulation is made as the clinical status of the patient evolves and is based on step-wise decisions made during the care of this patient according to specific patient's needs and the logistics available at the corresponding institution.

Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure

2021 ◽  
pp. 1-8
Author(s):  
Jason M. Thomas ◽  
David N. Dado ◽  
Anthony P. Basel ◽  
James K. Aden ◽  
Sarah B. Thomas ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Fluid Management ◽  
Arterial Oxygen ◽  
Membrane Oxygenation ◽  
Negative Fluid Balance

<b><i>Introduction:</i></b> Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients. <b><i>Methods:</i></b> We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls. <b><i>Results:</i></b> After 72 h, the treatment group had a fluid balance of −3840 mL versus + 425 mL (<i>p</i> ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10–5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, <i>p</i> ≤ 0.05). We did not observe any significant difference in renal outcomes. <b><i>Conclusions:</i></b> The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction.

scholarly journals Precision Fluid Management in Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 266-278 ◽  
Author(s):  
Raghavan Murugan ◽  
Eric Hoste ◽  
Ravindra L. Mehta ◽  
Sara Samoni ◽  
Xiaoqiang Ding ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Fluid Management ◽  
Standards Of Care ◽  
Future Research ◽  
Acid Base ◽  
Plasma Electrolyte ◽  
The Individual

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.

“Awake” Extracorporeal Membrane Oxygenation Combined With Continuous Renal Replacement Therapy For the Treatment of Severe Chemical Gas Inhalation Lung Injury

2020 ◽  
Vol 41 (4) ◽  
pp. 908-912
Author(s):  
Yang Li ◽  
ChunShui Cao ◽  
Liang Huang ◽  
HuaWei Xiong ◽  
HongTao Mao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Renal Replacement Therapy ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Severe Disease ◽  
Fluid Management ◽  
Membrane Oxygenation ◽  
Gas Inhalation

Abstract Lung injury caused by chemical gas inhalation is a common clinically severe disease that very easily progresses to acute respiratory distress syndrome (ARDS). Traditional respiratory support consists mainly of mechanical ventilation, but the prognosis of this condition is still poor. “Awake” extracorporeal membrane oxygenation (ECMO) maintains oxygenation, improves ventilation, adequately allows the injured lungs to rest, and avoids complications associated with sedation, intubation, and mechanical ventilation. Continuous renal replacement therapy (CRRT) can provide better fluid management and reduce pulmonary edema. Herein, we describe the case of a patient with severe chemical gas inhalation lung injury who failed to respond to traditional mechanical ventilation and was subsequently treated with awake ECMO combined with CRRT.

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