Balakumar Vikram, Murugan Raghavan
Department of Critical Care Medicine, Mercy Hospitals, Springfield, MO, USA; Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: https://twitter.com/vikrambalakumar.
Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 220, Room 206, Pittsburgh, PA 15261, USA.
Crit Care Clin. 2021 Apr;37(2):433-452. doi: 10.1016/j.ccc.2020.11.006. Epub 2021 Feb 13.
Emerging evidence from observational studies suggests that both slower and faster net ultrafiltration rates during kidney replacement therapy are associated with increased mortality in critically ill patients with acute kidney injury and fluid overload. Faster rates are associated with ischemic organ injury. The net ultrafiltration rate should be prescribed based on patient body weight in milliliters per kilogram per hour, with close monitoring of patient hemodynamics and fluid balance. Randomized trials are required to examine whether moderate net ultrafiltration rates compared with slower and faster rates are associated with reduced risk of hemodynamic instability, organ injury, and improved outcomes.
观察性研究的新证据表明，在急性肾损伤和液体超负荷的危重症患者中，肾脏替代治疗期间较慢和较快的净超滤率均与死亡率增加有关。较快的超滤率与缺血性器官损伤有关。净超滤率应根据患者体重以每千克每小时毫升数来规定，并密切监测患者的血流动力学和液体平衡。需要进行随机试验，以检验与较慢和较快超滤率相比，适度的净超滤率是否与降低血流动力学不稳定、器官损伤风险及改善预后相关。
