资源有限环境下重症监护病房急性肾损伤的诊断和治疗的现行实践。

Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings.

机构信息

Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.

Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

出版信息

J Crit Care. 2018 Aug;46:44-49. doi: 10.1016/j.jcrc.2018.04.007. Epub 2018 Apr 11.

DOI:10.1016/j.jcrc.2018.04.007

PMID:29669237

Abstract

PURPOSE

In a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand.

MATERIALS AND METHODS

Questionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview.

RESULTS

The response rate was 80.6% (129 physicians). AKI diagnosis was mostly made by using KDIGO criteria (36.7%). A common diagnostic investigation of AKI was urinalysis (86%). Nephrologists had a major role (86.4%) in deciding the initiation and selection of renal replacement therapy (RRT) modality. Intermittent hemodialysis is the preferable mode of RRT (72.0%), followed by continuous renal replacement therapy (CRRT, 12%), sustained low efficiency dialysis (10.0%) and peritoneal dialysis (6.0%). Catheter insertion was predominantly performed by nephrologist (51.1%) with ultrasound guidance. The right internal jugular vein was the most common site of insertion (70.4%). The most common indication for CRRT was hemodynamic instability.

CONCLUSIONS

Amid increasing concern of AKI in the ICU, our study provides the insight into the management of AKI in resource limited settings.

摘要

目的

在资源有限的情况下，基于系统数据收集，有关急性肾损伤（AKI）管理的信息很少。本调查旨在描述泰国重症监护病房（ICU）中 AKI 的当前管理情况。

材料和方法

2014 年 1 月至 12 月期间，向泰国 160 名参与重症监护的医生分发了问卷。通过在线调查平台或电话访谈进行了分发。

结果

应答率为 80.6%（129 名医生）。AKI 的诊断主要采用 KDIGO 标准（36.7%）。AKI 的常见诊断性检查是尿液分析（86%）。肾脏病专家在决定开始和选择肾脏替代治疗（RRT）方式方面发挥了主要作用（86.4%）。间歇性血液透析是 RRT 的首选模式（72.0%），其次是连续肾脏替代治疗（CRRT，12%）、持续低效透析（10.0%）和腹膜透析（6.0%）。导管插入术主要由肾脏病专家（51.1%）进行，同时采用超声引导。最常见的插入部位是右颈内静脉（70.4%）。CRRT 的最常见指征是血流动力学不稳定。