Glaser Jacob, Zeman Joseph, Noble Stephen, Fernandez Nathanial
Naval Medical Research Unit San Antonio, Combat Casualty Care Directorate, 3650 Chambers Pass JBSA Fort Sam Houston, San Antonio, TX 78234.
Department of Pulmonary Critical Care, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
Mil Med. 2018 Jan 1;183(1-2):e167-e171. doi: 10.1093/milmed/usx017.
Acute kidney injury is a common complication of both civilian and military trauma. The lack of dedicated resources restrict dialysis in the forward setting. We report a case of a combat polytrauma and renal failure, using continuous arteriovenous hemofiltration to clear uremia and remove volume, allowing for ventilator liberation and safe disposition.
The patient presented with traumatic lower extremity injuries and abdominal wounds and developed acute post-traumatic renal failure. Using available supplies, the patient was cannulated for continuous arteriovenous hemofiltration. Aggressive fluid and electrolyte management accomplished specific goals of ventilator liberation and clearance of uremia.
Over 48 h, blood urea nitrogen was reduced from 101 mg/dL to 63 mg/dL. Creatinine was reduced from 8.2 mg/dL to 4.7 mg/dL. Acute respiratory distress syndrome was improved reducing P:F (PaO2:FiO2) ratio from 142 to 210. The patient was extubated and transferred safely.
The ability to perform acute dialysis can be lifesaving. Although resource constrained, we created a dialysis system in the forward environment with a filter and universally available equipment. This represents the first described use of continuous arteriovenous hemofiltration at the NATO Role 3 hospital in Afghanistan. This technique represents another potential tool for deployed trauma teams to improve care.
急性肾损伤是 civilian 和军事创伤的常见并发症。在前沿环境中，缺乏专门资源限制了透析治疗。我们报告一例战斗多发伤合并肾衰竭病例，采用持续动静脉血液滤过清除尿毒症毒素并去除多余液体，从而实现脱机并安全转运。
该患者因下肢创伤和腹部伤口就诊，并发生创伤后急性肾衰竭。利用现有设备，为患者进行了持续动静脉血液滤过置管。积极的液体和电解质管理实现了脱机及清除尿毒症毒素的特定目标。
在48小时内，血尿素氮从101mg/dL降至63mg/dL。肌酐从8.2mg/dL降至4.7mg/dL。急性呼吸窘迫综合征得到改善，P:F（动脉血氧分压：吸入氧分数）比值从142升至210。患者成功脱机并安全转运。
进行急性透析的能力可能挽救生命。尽管资源有限，但我们利用滤器和通用设备在前沿环境中创建了一个透析系统。这是在阿富汗北约三级医院首次描述的持续动静脉血液滤过的应用。这项技术是部署创伤团队改善救治的又一潜在工具。
