Shen Bo, Xu Jiarui, Wang Yimei, Jiang Wuhua, Teng Jie, Ding Xiaoqiang
Contrib Nephrol. 2018;194:134-145. doi: 10.1159/000485611. Epub 2018 Mar 29.
Continuous renal replacement therapy (CRRT) is one of the most predominant forms of renal replacement therapy (RRT) currently in use now, this therapy being the initial RRT modality in most critically ill patients. However, in general, the quality of CRRT is still suboptimal. The quality of CRRT is affected by many factors, including the optimal prescription and precision delivery, the CRRT providers' professional level, and the CRRT device used. Establishment of a comprehensive quality control system covering all the aspects and procedures of CRRT is essential. Quality measures for structure, process, and outcome of CRRT need to be developed, evaluated, and implemented to ensure the high quality of CRRT. Some CRRT quality improvement methods such as the professional education and specialized team and the application of citrate anticoagulation to extend filter lifespan have been found to be potentially beneficial but need further validation. After all, much work is needed in this field because of the heterogeneity in CRRT practice. More evidence is needed to improve the CRRT quality control system. These are challenges that will need to be addressed in the future.
连续性肾脏替代治疗(CRRT)是目前使用的最主要的肾脏替代治疗(RRT)形式之一,该治疗是大多数危重症患者的初始RRT模式。然而,总体而言,CRRT的质量仍未达到最佳。CRRT的质量受许多因素影响,包括最佳处方和精确给药、CRRT提供者的专业水平以及所使用的CRRT设备。建立涵盖CRRT所有方面和程序的全面质量控制体系至关重要。需要制定、评估和实施CRRT结构、过程和结果的质量措施,以确保CRRT的高质量。一些CRRT质量改进方法,如专业教育和专业团队以及应用枸橼酸盐抗凝以延长滤器使用寿命,已被发现可能有益,但需要进一步验证。毕竟,由于CRRT实践的异质性,该领域仍有许多工作要做。需要更多证据来改进CRRT质量控制体系。这些都是未来需要解决的挑战。