Fealy Nigel, Aitken Leanne, du Toit Eugene, Lo Serigne, Baldwin Ian
1Department of Intensive Care Medicine, Austin Hospital, Melbourne, VIC, Australia. 2School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia. 3School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia. 4Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia. 5Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia. 6School of Health Sciences, City, University of London, London, United Kingdom. 7School of Medical Science, Griffith University, Gold Coast, Sydney, QLD, Australia. 8Melanoma Institute Australia, Research and Biostatistics group, Wollstonecraft, NSW, Australia.
Crit Care Med. 2017 Oct;45(10):e1018-e1025. doi: 10.1097/CCM.0000000000002568.
To determine whether blood flow rate influences circuit life in continuous renal replacement therapy.
Prospective randomized controlled trial.
Single center tertiary level ICU.
Critically ill adults requiring continuous renal replacement therapy.
Patients were randomized to receive one of two blood flow rates: 150 or 250 mL/min.
The primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5-26 hr] vs 10 hr [4.2-17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60-1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting.
There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.
确定血流量是否会影响持续肾脏替代治疗中的管路使用寿命。
前瞻性随机对照试验。
单中心三级重症监护病房。
需要持续肾脏替代治疗的重症成年患者。
患者被随机分为接受两种血流量之一：150或250毫升/分钟。
主要结局指标是管路使用寿命，以小时为单位进行测量。收集管路和患者数据，直到每个管路发生凝血或因非凝血原因被选择性终止。发生凝血的管路数据以中位数（四分位间距）表示，并使用Mann-Whitney U检验进行比较。使用对数秩检验比较发生凝血的管路的生存概率。使用风险比分析管路凝血数据的重复事件。100名患者被随机分组，96名完成研究（150毫升/分钟组，n = 49；250毫升/分钟组，n = 47），共使用462条管路（245条以150毫升/分钟运行，217条以250毫升/分钟运行）。两组第一条发生凝血的管路的中位使用寿命相似（150毫升/分钟组：9.1小时[5.5 - 26小时] 对比10小时[4.2 - 17小时]；p = 0.37）。与150毫升/分钟相比，将血流量设定为250毫升/分钟进行持续肾脏替代治疗时，发生凝血的可能性并无增加（风险比，1.00 [0.60 - 1.69]；p = 0.68）。性别、体重指数、体重、血管通路类型、持续肾脏替代治疗的时长、部位和模式或国际标准化比值对凝血风险无影响。与使用肝素策略相比，无抗凝的持续肾脏替代治疗更易导致凝血（风险比，1.62；p = 0.003）。活化部分凝血活酶时间延长（风险比，0.98；p = 0.002）和血小板计数降低（风险比，1.19；p = 0.03）与管路凝血可能性降低相关。
在持续肾脏替代治疗中，使用250或150毫升/分钟的血流量，管路使用寿命无差异。
