一种提高2019冠状病毒病危重症急性肾损伤患者连续性肾脏替代治疗管路存活时间的方法。
A Method to Improve Continuous Renal Replacement Therapy Circuit Survival Time in Critically Ill Coronavirus Disease 2019 Patients With Acute Kidney Injury.
作者信息
Volbeda Meint, Londema Mark, van Meurs Matijs, Stegeman Coen A, Gansevoort Ron T, Berger Stefan P, van der Voort Peter H J, Franssen Casper F M
机构信息
Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Crit Care Explor. 2020 Oct 15;2(10):e0258. doi: 10.1097/CCE.0000000000000258. eCollection 2020 Oct.
OBJECTIVES
Optimizing continuous renal replacement therapy circuit survival in coronavirus disease 2019 patients admitted to the ICU.
DESIGN
Single-center prospective observational cohort study.
SETTING
Tertiary academic teaching ICU.
PATIENTS
Between March 19, 2020, and May 18, 2020, 11 out of 101 coronavirus disease 2019 patients were treated with continuous renal replacement therapy comprising 127 continuous renal replacement therapy days.
INTERVENTIONS
A nonrandomized observational comparison of circuit anticoagulation modalities using standard regional citrate anticoagulation, continuous IV heparin anticoagulation, or the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin.
MEASUREMENTS AND MAIN RESULTS
Circuit patency was shorter than 24 hours using standard regional citrate anticoagulation or continuous IV heparin anticoagulation. Median circuit survival increased with at least 165% when the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin was applied.
CONCLUSIONS
Continuous renal replacement therapy circuit patency is diminished in coronavirus disease 2019 ICU patients. Combining regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin increases filter survival as compared with regional citrate anticoagulation alone in this nonrandomized observational study.
目的
优化入住重症监护病房（ICU）的2019冠状病毒病患者的连续性肾脏替代治疗回路的使用寿命。
设计
单中心前瞻性观察性队列研究。
地点
三级学术教学ICU。
患者
在2020年3月19日至2020年5月18日期间，101例2019冠状病毒病患者中有11例接受了连续性肾脏替代治疗，共进行了127个连续性肾脏替代治疗日。
干预措施
使用标准局部枸橼酸盐抗凝、持续静脉注射肝素抗凝或局部枸橼酸盐抗凝与持续静脉注射肝素或治疗剂量那屈肝素联合使用，对回路抗凝方式进行非随机观察性比较。
测量指标和主要结果
使用标准局部枸橼酸盐抗凝或持续静脉注射肝素抗凝时，回路通畅时间短于24小时。当局部枸橼酸盐抗凝与持续静脉注射肝素或治疗剂量那屈肝素联合使用时，回路生存时间中位数增加了至少165%。
结论
在2019冠状病毒病ICU患者中，连续性肾脏替代治疗回路的通畅性降低。在这项非随机观察性研究中，与单独使用局部枸橼酸盐抗凝相比，局部枸橼酸盐抗凝与持续静脉注射肝素或治疗剂量那屈肝素联合使用可提高滤器生存率。
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