Yanting Zhang, Pu Zhang, Gui Hou, Anlong Zheng, Meng Xiao, Jin Li, Jing Ma, Xinbo Ding, Zhaoyang Li
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Hubei Clinical Research Center for Critical Care Medicine, Wuhan, China.
Nurs Crit Care. 2025 Jul;30(4):e13225. doi: 10.1111/nicc.13225. Epub 2024 Dec 9.
Continuous renal replacement therapy (CRRT) is a method of blood purification, which is widely used in the treatment of critical diseases as a means of multiple organ function protection and life support therapy. However, because of the serious condition of ICU (intensive care unit) patients, CRRT needs to be carried out continuously, but the treatment is interrupted ahead of time as a result of various conditions, which not only affects the treatment effect but also increases the patient cost.
To evaluate intervention measures to improve the filter life of CRRT in critically ill patients, and also to identify which interventions are considered 'promising interventions'.
This is a systematic review. Seven databases were searched using terms related to the concepts of 'continuous renal replacement therapy' and 'filter life', from the establishment of the database to 31 December 2023. The quality of the methodology included in the study was assessed using standard evaluation tools developed by the Effective Public Health Practice Project (EPHPP), and pre-established criteria were used to identify 'promising interventions'.
A total of 28 studies were included, of which 7 were rated 'strong' in terms of design and methodological quality, and the others were 'medium'. The most commonly identified interventions to extend the life of CRRT filters include the use of sodium citrate anticoagulation, the choice of CVVHD or CVVHDF or pre-diluted CVVH for CRRT and the use of personalized sodium citrate anticoagulant regimens to reduce the incidence of filter clotting. The intervention measures of 14 studies were statistically significant, while the other 14 studies were not statistically significant. Interventions in nine studies were identified as 'promising interventions' because they were published within 10 years, with a medium or strong methodological quality rating, significant positive results and a strong evidence base.
In the promising interventions study, citrate anticoagulation and CVVHD or CVVHDF models were recommended to significantly prolong filter life. However, more high-quality studies are needed to identify interventions that can prolong the life of CRRT filters in critically ill patients, thereby supplementing the literature in this field. The existing studies lack blinding and have limited quality. Future studies should be carried out with the goal of 'best evidence', and the interventions should be more universal and clinically practical.
This study uses the method of systematic review to scientifically and rigorously provide some suggestions for extending the life of CRRT filters in critically ill patients, such as 'By implementing personalized citrate anticoagulation protocols, the incidence of CRRT filter life shortening due to coagulation can be reduced', which can reduce the cost of patients and improve the quality of treatment to a certain extent in clinical practice.
连续性肾脏替代治疗（CRRT）是一种血液净化方法，作为多器官功能保护和生命支持治疗手段，广泛应用于危重症疾病的治疗。然而，由于重症监护病房（ICU）患者病情严重，CRRT需要持续进行，但因各种情况治疗提前中断，这不仅影响治疗效果，还增加了患者费用。
评估改善危重症患者CRRT滤器使用寿命的干预措施，并确定哪些干预措施被视为“有前景的干预措施”。
这是一项系统评价。使用与“连续性肾脏替代治疗”和“滤器寿命”概念相关的术语，检索了7个数据库，检索时间从数据库建立至2023年12月31日。使用有效公共卫生实践项目（EPHPP）开发的标准评估工具评估纳入研究的方法学质量，并使用预先设定的标准来确定“有前景的干预措施”。
共纳入28项研究，其中7项在设计和方法学质量方面被评为“强”，其他为“中”。最常确定的延长CRRT滤器使用寿命的干预措施包括使用枸橼酸钠抗凝、选择CVVHD或CVVHDF或预稀释的CVVH进行CRRT以及使用个性化枸橼酸钠抗凝方案以降低滤器凝血发生率。14项研究的干预措施具有统计学意义，而其他14项研究无统计学意义。9项研究中的干预措施被确定为“有前景的干预措施”，因为它们在10年内发表，方法学质量评级为中或强，结果呈显著阳性且证据充分。
在有前景的干预措施研究中，推荐使用枸橼酸钠抗凝和CVVHD或CVVHDF模式可显著延长滤器使用寿命。然而，需要更多高质量研究来确定可延长危重症患者CRRT滤器使用寿命的干预措施，从而补充该领域的文献。现有研究缺乏盲法且质量有限。未来研究应以“最佳证据”为目标进行，干预措施应更具普遍性和临床实用性。
本研究采用系统评价方法，科学严谨地为延长危重症患者CRRT滤器使用寿命提供了一些建议，如“通过实施个性化枸橼酸钠抗凝方案，可降低因凝血导致CRRT滤器使用寿命缩短的发生率”，在临床实践中可在一定程度上降低患者费用并提高治疗质量。
