Ricci Zaccaria, Romagnoli Stefano, Ronco Claudio
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy; Department of Anesthesia and Intensive Care, Azienda Ospedaliero Careggi, Florence, Italy.
F1000Res. 2016 Jan 25;5. doi: 10.12688/f1000research.6935.1. eCollection 2016.
During the last few years, due to medical and surgical evolution, patients with increasingly severe diseases causing multiorgan dysfunction are frequently admitted to intensive care units. Therapeutic options, when organ failure occurs, are frequently nonspecific and mostly directed towards supporting vital function. In these scenarios, the kidneys are almost always involved and, therefore, renal replacement therapies have become a common routine practice in critically ill patients with acute kidney injury. Recent technological improvement has led to the production of safe, versatile and efficient dialysis machines. In addition, emerging evidence may allow better individualization of treatment with tailored prescription depending on the patients' clinical picture (e.g. sepsis, fluid overload, pediatric). The aim of the present review is to give a general overview of current practice in renal replacement therapies for critically ill patients. The main clinical aspects, including dose prescription, modality of dialysis delivery, anticoagulation strategies and timing will be addressed. In addition, some technical issues on physical principles governing blood purification, filters characteristics, and vascular access, will be covered. Finally, a section on current standard nomenclature of renal replacement therapy is devoted to clarify the "Tower of Babel" of critical care nephrology.
在过去几年中，由于医学和外科手术的发展，患有日益严重疾病并导致多器官功能障碍的患者经常被收治入重症监护病房。当器官衰竭发生时，治疗选择往往缺乏特异性，主要是支持生命功能。在这些情况下，肾脏几乎总是会受到影响，因此，肾脏替代治疗已成为急性肾损伤重症患者的常见常规治疗手段。最近的技术进步使得安全、通用且高效的透析机得以生产。此外，新出现的证据可能使根据患者的临床表现（如脓毒症、液体超负荷、儿科情况）进行个性化定制治疗成为可能。本综述的目的是对重症患者肾脏替代治疗的当前实践进行总体概述。将探讨主要的临床方面，包括剂量处方、透析方式、抗凝策略和时机。此外，还将涵盖血液净化的物理原理、滤器特性和血管通路等一些技术问题。最后，专门有一部分关于肾脏替代治疗的当前标准命名法，旨在厘清重症监护肾脏病学中的“巴别塔”乱象。
