【持续性肾脏替代治疗crrt英文精品课件】pediatric crrt the prescription

《【持续性肾脏替代治疗crrt英文精品课件】pediatric crrt the prescription》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、PediatricCRRT:ThePrescriptionStuartL.Goldstein,MDProfessorofPediatricsBaylorCollegeofMedicineWhat’sinaCRRTPrescription?Indication(Why?Who?When?)TechnicalAspects(What?)Nutrition(Maxvold)Anticoagulation(Brophy)Access(Bunchman)CRRTDelivery(How?)BloodpumpflowratesModalityPrimingDoseWhyCRRTi

2、nAKI?CriticallyillpatientAdvantagesSlowerbloodflowsSlowerUFratesUFratescanbeprescriptive(versusPD)AdjustUFrateswithhourlypatientintakeIncreasedcytokine(badhumors)removal?DisadvantagesIncreasedcytokine(goodhumors)removal?Non-dialysispersonnelwithmanyotherbedsideresponsibilitiesrequiredtom

3、onitorcircuitWhenShouldCRRTBeStarted?StandardAKIcriterianotresponsivetomedicaltherapyORonlypreventablewithlimitingadequatenutritionUremiaHyperkalemiaAcidosisFluidOverloadPreventionofworseningfluidoverload?TimingofPediatricRRTNoadequatedefinitionfor“timingofinitiation”Absenceofagenerallya

4、ccepted,validatedandappliedAKIdefinitionhasimpededtheadequateinvestigationofthisquestionThedecisiontoinitiateRRTaffectedbyStronglyheldphysicianbeliefsPatientcharacteristicsOrganizationalcharacteristicsRetrospectiveevaluationof226childrenwhoreceivedRRTforAKIfrom1992-1998Pressorusesurrogat

5、emarkerforpatientseverityofillnessSurvivaldefinedatPICUdischargePercentFluidOverloadCalculation%FOatCVVHinitiation=[FluidIn-FluidOutICUAdmitWeight]*100%FluidIn=TotalInputfromICUadmittoCRRTinitiationFluidOut=TotalOutputfromICUadmittoCRRTinitiationLesser%FOatCVVH(D)initiationwasassociatedw

6、ithimprovedoutcome(p=0.03)Lesser%FOatCVVH(D)initiationwasalsoassociatedwithimprovedoutcomewhensamplewasadjustedforseverityofillness(p=0.03;multipleregressionanalysis)FluidOverloadThresholdsatCRRTInitiationandMortalityAuthorFOThresholdOutcomeGoldsteinFluidthresholdsnotassessedGillespie10%

7、ORdeath3.02>10%FOFoland10%increment1.78ORdeathforeach10%FOincreaseGoldstein(ppCRRT)20%<20%FO:58%survival>20%FO:40%survivalHayes20%ORdeath6.1>20%FOTheEvolutionofIdeatoPracticeParadigmSinglecenterstudyRegistryRandomizedTrialProspectivePediatricCRRT(ppCRRT)Registry:Phase1Des