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连续肾脏替代治疗:审查当前最佳实践,为重症患者提供高质量的体外治疗。

Continuous Renal Replacement Therapy: Reviewing Current Best Practice to Provide High-Quality Extracorporeal Therapy to Critically Ill Patients.

机构信息

Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and Division of Nephrology, University of Arkansas for Medial Sciences, Little Rock, AK.

Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and Division of Nephrology, University of Arkansas for Medial Sciences, Little Rock, AK.

出版信息

Adv Chronic Kidney Dis. 2017 Jul;24(4):213-218. doi: 10.1053/j.ackd.2017.05.003.

Abstract

Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. While significant gaps in medical evidence regarding CRRT persist, the growing evidence base supports evolving best practice and consensus to define high-quality CRRT. Unfortunately, there is wide variability in CRRT operating characteristics and limited uptake of these best practices. This article will briefly review the current best practice on important aspects of CRRT delivery including CRRT dose, anticoagulation, dialysis vascular access, fluid management, and drug dosing in CRRT.

摘要

连续肾脏替代治疗(CRRT)的应用在全球范围内不断扩大。尽管技术不断改进,但 CRRT 仍然是一种复杂的干预措施。要提供高质量的 CRRT,需要多学科团队的密切合作,包括重症医学、肾脏病学、护理、药学和营养支持团队的成员。尽管关于 CRRT 的医学证据仍存在显著差距,但不断增加的证据基础支持不断发展的最佳实践和共识,以定义高质量的 CRRT。不幸的是,CRRT 的操作特性存在很大差异,并且这些最佳实践的采用率有限。本文将简要回顾 CRRT 实施的重要方面的当前最佳实践,包括 CRRT 剂量、抗凝、透析血管通路、液体管理和 CRRT 中的药物剂量。

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