Clinical Nurse & Adjunct Research Fellow (Curtin University), Intensive Care Unit, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia.
Director Research & Development, School of Nursing & Midwifery, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia.
Aust Crit Care. 2017 Nov;30(6):314-319. doi: 10.1016/j.aucc.2016.05.004. Epub 2016 Jun 21.
An effect of severe acute kidney injury (AKI) is the development of oliguria and subsequent retention of fluid. Recent studies have reported an association between fluid overload and increased mortality in critically ill patients. Achieving fluid balance control through haemofiltration is an important part of dialysis dose delivery in continuous renal replacement therapy (CRRT).
(1) Compare the prescribed dose with the delivered dose of dialysis and haemofiltration for CRRT. (2) Identify how interruptions and delays in treatment delivery impact on fluid balance management.
A retrospective cohort study was undertaken of daily fluid balance and fluid removal for patients who required CRRT. Each observation chart and prescription order for every treatment day was reviewed. Each patient was exposed to the same treatment mode, predilutional continuous veno-venous haemodiafiltration (CVVHDf). A comparison was made of fluid balance control delivered to the patient over 24h against the dose of fluid removal prescribed.
The observation charts of 46 consecutive patients were reviewed for total of 288 treatment days. Median number of days patients received CRRT was 5 (range 1-31). Median circuit life was 16h (range 0-66). Fluid removal targets did not occur in 75 (26%) treatment days. Median daily fluid removal shortfall was 300mL (range 25-3800mL). Mean number of daily treatment interruptions 1.25, SD±0.49. The most frequent cause of treatment downtime was circuit clotting (45%). Mean length of treatment down time was 3.71, SD±4.36h excluding delays attributed to assessment of renal function.
In over a quarter of treatment days prescribed fluid removal was not achieved. Frequency of interruptions and delays in resumption of treatment compromised fluid balance control. Daily targets for fluid removal which are not achieved contribute to fluid overload and may compromise the outcome of patients who require CRRT.
严重急性肾损伤 (AKI) 的一个影响是少尿和随后的液体潴留。最近的研究报告称，在危重病患者中，液体超负荷与死亡率增加之间存在关联。通过血液滤过实现液体平衡控制是连续性肾脏替代治疗 (CRRT) 中透析剂量输送的重要组成部分。
(1) 比较 CRRT 中透析和血液滤过的规定剂量与实际剂量。(2) 确定治疗输送中断和延迟如何影响液体平衡管理。
对需要 CRRT 的患者的每日液体平衡和液体清除进行回顾性队列研究。对每个治疗日的观察图表和处方医嘱进行了审查。每个患者都接受了相同的治疗模式，预稀释连续静脉-静脉血液透析滤过 (CVVHDf)。将患者 24 小时内接受的液体平衡控制与规定的液体清除剂量进行了比较。
共回顾了 46 例连续患者的观察图表，共 288 个治疗日。患者接受 CRRT 的中位数天数为 5 天（范围 1-31 天）。中位数回路寿命为 16 小时（范围 0-66 小时）。75 个（26%）治疗日未达到液体清除目标。中位数每日液体清除不足量为 300 毫升（范围 25-3800 毫升）。每日治疗中断的平均次数为 1.25 次，SD±0.49。治疗停机时间最常见的原因是回路凝血（45%）。不包括肾功能评估引起的延迟，平均停机时间为 3.71 小时，SD±4.36 小时。
在超过四分之一的治疗日中，规定的液体清除量未达到。中断和延迟恢复治疗的频率会影响液体平衡控制。未达到的每日液体清除目标会导致液体超负荷，并可能影响需要 CRRT 的患者的预后。
