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Continuous haemofiltration in the intensive care unit.

Bellomo R, Ronco C - Crit Care (2000)

Bottom Line: Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior.Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients.The evolution and use of CRRT is likely to continue and grow over the next decade.

View Article: PubMed Central - HTML - PubMed

Affiliation: Austin & Repatriation Medical Centre, Melbourne, Victoria, Australia. rb@austin.unimelb.edu.au

ABSTRACT
Continuous renal replacement therapy (CRRT) was first described in 1977 for the treatment of diuretic-unresponsive fluid overload in the intensive care unit (ICU). Since that time this treatment has undergone a remarkable technical and conceptual evolution. It is now available in most tertiary ICUs around the world and has almost completely replaced intermittent haemodialysis (IHD) in some countries. Specially made machines are now available, and venovenous therapies that use blood pumps have replaced simpler techniques. Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior. The use of CRRT has also spurred renewed interest in the broader concept of blood purification, particularly in septic states. Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients. The evolution and use of CRRT is likely to continue and grow over the next decade.

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The design of a CVVHD circuit using a simple blood pump, volumetric pumps for dialysate control and a double lumen catheter for vascular access.
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Figure 2: The design of a CVVHD circuit using a simple blood pump, volumetric pumps for dialysate control and a double lumen catheter for vascular access.

Mentions: Once venovenous therapy is applied, blood flow rate must be controlled. A peristaltic pump module is necessary to achieve this goal. This module must have the appropriate air-trap and pressure monitors to ensure patient safety. In this setting, either continuous venovenous haemofiltration (CVVH) or continuous venovenous haemodialysis (CVVHD), or a combination of both [continuous venovenous haemodiafiltration (CVVHDF)], may be chosen. All techniques will deliver excellent uraemic control provided ultrafiltrate flow and/or dialysate flow is adequate. In fact, with sufficient blood flow (≥ 200 ml/min) and membrane surface (≥ 0.8 m2), CVVH without pump-driven ultrafiltrate control initially will spontaneously deliver high ultrafiltration rates (1.5-2 l/h), and thereby high solute clearances without the need for counter-current dialysate flow [11]. To facilitate nursing care, however, ultrafiltration or dialysate flow should be pump-controlled (Figs 1 and 2). All new machines for CRRT possess such technology. If only a simple blood module is available, ultrafiltration (and replacement fluid) or dialysate flow rate can be controlled by means of a standard volumetric pump. Such volumetric pumps are ubiquitous in the ICU [12].


Continuous haemofiltration in the intensive care unit.

Bellomo R, Ronco C - Crit Care (2000)

The design of a CVVHD circuit using a simple blood pump, volumetric pumps for dialysate control and a double lumen catheter for vascular access.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137261&req=5

Figure 2: The design of a CVVHD circuit using a simple blood pump, volumetric pumps for dialysate control and a double lumen catheter for vascular access.
Mentions: Once venovenous therapy is applied, blood flow rate must be controlled. A peristaltic pump module is necessary to achieve this goal. This module must have the appropriate air-trap and pressure monitors to ensure patient safety. In this setting, either continuous venovenous haemofiltration (CVVH) or continuous venovenous haemodialysis (CVVHD), or a combination of both [continuous venovenous haemodiafiltration (CVVHDF)], may be chosen. All techniques will deliver excellent uraemic control provided ultrafiltrate flow and/or dialysate flow is adequate. In fact, with sufficient blood flow (≥ 200 ml/min) and membrane surface (≥ 0.8 m2), CVVH without pump-driven ultrafiltrate control initially will spontaneously deliver high ultrafiltration rates (1.5-2 l/h), and thereby high solute clearances without the need for counter-current dialysate flow [11]. To facilitate nursing care, however, ultrafiltration or dialysate flow should be pump-controlled (Figs 1 and 2). All new machines for CRRT possess such technology. If only a simple blood module is available, ultrafiltration (and replacement fluid) or dialysate flow rate can be controlled by means of a standard volumetric pump. Such volumetric pumps are ubiquitous in the ICU [12].

Bottom Line: Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior.Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients.The evolution and use of CRRT is likely to continue and grow over the next decade.

View Article: PubMed Central - HTML - PubMed

Affiliation: Austin & Repatriation Medical Centre, Melbourne, Victoria, Australia. rb@austin.unimelb.edu.au

ABSTRACT
Continuous renal replacement therapy (CRRT) was first described in 1977 for the treatment of diuretic-unresponsive fluid overload in the intensive care unit (ICU). Since that time this treatment has undergone a remarkable technical and conceptual evolution. It is now available in most tertiary ICUs around the world and has almost completely replaced intermittent haemodialysis (IHD) in some countries. Specially made machines are now available, and venovenous therapies that use blood pumps have replaced simpler techniques. Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior. The use of CRRT has also spurred renewed interest in the broader concept of blood purification, particularly in septic states. Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients. The evolution and use of CRRT is likely to continue and grow over the next decade.

Show MeSH
Related in: MedlinePlus