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Continuous Renal Replacement Therapy (CRRT)

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Continuous Renal Replacement Therapy (CRRT) Maureen Walter,Raquel Lomeli Anika Stevenson,Nellie Preble What is CRRT Continuous Dialysis of Critically Ill Patients in ... – PowerPoint PPT presentation

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Title: Continuous Renal Replacement Therapy (CRRT)


1
Continuous Renal Replacement Therapy (CRRT)
  • Maureen Walter,Raquel Lomeli
  • Anika Stevenson,Nellie Preble

2
What is CRRT
  • Continuous Dialysis of Critically Ill Patients in
    the ICU
  • The concept behind CRRT is to dialyse patients in
    a more physiologic way, slowly over 24 hours,
    just like the kidney. Intensive care patients are
    particularly suited to the techniques as they are
    by definition, bed bound and when acutely sick,
    intolerant of fluid swings associated with IHD
  • What is the difference between CRRT and IHD
  • Slow continuous natural like the kidneys vs
    rapid/qod
  • Why is it necessary in the ICU
  • Patients are hemodynamically unstable

3
IHD vs CRRT
  • While IHD is an important treatment therapy for
    patients with ESRD it may be contraindicated for
    patients in the ICU suffering from ARF due to
    their other disease processes.
  • IHD is done only 3-4 times a week in order to
    extract 2 days worth of accumulated fluid. The
    process takes about 3-4 hours.
  • CRRT is a continuous process that slowly and
    gently provides for the removal of fluids
    electrolytes and uremic toxins.

4
Indications for RRT in Critically Ill Patients
  • Oliguria (urine output lt200ml/12hr)
  • Anuria (urine output lt50ml/12hr)
  • Hyperkalemia (Kgt6.5mmol/l and rising)
  • Severe acidemia (pHlt7.1)
  • Azotemia (ureagt30mmol/l or creat gt300umol/l)
  • Pulmonary edema
  • Uremic encephalopathy
  • Uremic pericarditis
  • Uremic myopathy or neuropathy
  • Severe Dysnatremia (Nagt160 or lt115mmol/l)
  • Hyperthermia
  • Drug overdose with filterable toxins
    (Lithium,Vancomycin,Procainamide etc.)
  • Anasarca
  • Imminent/ongoing massive blood product
    administration

5
Major complications of IHD
  • Intermittent hemodialysis (IHD) for critically
    ill patients may be limited or ineffective due to
    the critical nature of their ilness. Volume
    overload and hemodynamic instability may not be
    treated adequately with conventional forms of
    dialysis.
  • Complications of IHD
  • Systemic hypotension(leads to Multi organ
    dysfunction
  • Arrhythmias
  • Hypoxemia
  • Hemmorrhage
  • Infection
  • Line related complications (e.g. pneumothorax)
  • Seizure/dialysis disequalibrium
  • Pyrogen reaction or hemolysis
  • ? Delay in recovery of renal function(r/t
    ischemia)
  • Fluid overload between treatments(Acute
    respiratory distress syndrome)

6
Why CRRT--Treatment Goals
  • Reduces hemodynamic instability preventing
    secondary ischemia
  • Precise Volume control/immediately adaptable
  • Ensures creatinine clearance
  • Uremic toxin removal
  • Effective control of uremia,hypophosphatemia,hyper
    kalemia
  • Acid base balance
  • Rapid control of metabolic acidosis
  • Electrolyte Management/dialisate to mirror ideal
    blood composition
  • Allows for provision of nutritional support
  • Management of sepsis/plasma cytokine filter
  • Safer for patients with head injuries
  • Probable advantage in terms of renal recovery
  • Improved nutritional support(full protein diet)

7
Accute Renal Failure
  • Acute renal failure is a common complication of
    critically ill patients in todays intensive care
    units.
  • Three types
  • Pre-decline in renal blood flow resulting in
    decreased renal perfusion
  • Intrainjury to kidneys by nephrotoxins resulting
    in tubular cell injury
  • Post obstruction to outflow
  • In the ICU most ARF is associated with prerenal
    and intrarenal failure.

8
Mortality related to ARF
  • 40-70
  • Factors
  • Increased age of patient population and multi
    system organ failure
  • How soon CRRT was started after admission
  • In one study Patients who survived were started
    on CRRT 8 days earlier than those who died
  • ComorbiditiesDM,HTN,CVD,ESRD,Malignancy etc
  • Gender--MalegtFemale

9
Summary of CRRT
  • Although ARF mortality remains high, CRRT is
    becoming the therapy of choice for the treatment
    of ARF in the critically ill patient.
  • Timely initiation of CRRT may improve patient
    survival
  • Surviving patients (without preexisting ESRD) are
    likely to experience recovery of renal function.
  • CRRT has many benefits including
  • Hemodynamic stability
  • Excellent fluid and solute removal
  • Enhanced cytokine removal and prevention of
    sepsis

10
Question
  • Prerenal failure occurs in response to
  • A. Uncontrolled hypertension
  • B. Decline in renal blood flow
  • C. Exposure to nephrotoxins
  • D. Obstruction to urine outflow

11
Question
  • Intermittent hemodyalisis of critically ill
    patients results in hemodynamic instability due
    to
  • A. Rapid urea removal
  • B. Excessive urea losses
  • C. Rapid fluid removal
  • D. excessive urine output

12
Question
  • The key indication for CRRT is
  • A. Respiratory failure on mechanical ventilation
  • B.Multisystem organ failure on vasopressors
  • C. Anuria with refractory hypertension
  • D. Fluid overload with hemodynamic instability
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