Vincent Jean-Louis
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium.
Contrib Nephrol. 2007;156:24-31. doi: 10.1159/000102012.
BACKGROUND/AIMS: Acute renal failure is a common complication in critically ill patients, affecting some 25% of intensive care unit (ICU) admissions, and is associated with high mortality rates of around 40-50%. Acute renal failure in the ICU frequently occurs as part of multiple organ failure (MOF).
We reviewed the pertinent medical literature related to the occurrence of acute renal failure in the ICU and its association with other organ failures. We also reviewed the literature related to different patient management strategies, notably the differences between 'closed' and 'open' ICU formats.
The increasingly common association of acute renal failure with other organ failures, in the context of a more generalized MOF, has important implications on patient care, moving management away from the realm of nephrologists and towards a more multidisciplinary approach. Closed ICU formats with intensivist-led care, supported by specialist consultation, have been shown to be associated with improved ICU outcomes.
ICU patients with acute renal failure should be managed using a multidisciplinary team approach led by an intensivist. Good collaboration and communication between intensivists and renal and other specialists is essential to insure the best possible care for ICU patients with renal disease.
背景/目的：急性肾衰竭是危重症患者常见的并发症，约25%的重症监护病房（ICU）收治患者受其影响，且死亡率高达40%-50%左右。ICU中的急性肾衰竭常作为多器官功能衰竭（MOF）的一部分出现。
我们回顾了与ICU中急性肾衰竭的发生及其与其他器官功能衰竭的关联相关的医学文献。我们还回顾了与不同患者管理策略相关的文献，特别是“封闭式”和“开放式”ICU模式之间的差异。
在更广泛的MOF背景下，急性肾衰竭与其他器官功能衰竭的关联日益常见，这对患者护理具有重要意义，使管理从肾脏病学家的领域转向更具多学科性的方法。由专科医生会诊支持的、由重症监护医生主导护理的封闭式ICU模式已被证明与改善ICU结局相关。
ICU中急性肾衰竭患者应采用由重症监护医生领导的多学科团队方法进行管理。重症监护医生与肾脏及其他专科医生之间良好的协作与沟通对于确保为患有肾脏疾病的ICU患者提供最佳护理至关重要。
