持续脏置换治疗的重症成年人当前的流体管理实践:一个双国,观察性研究
Kyle C White1,2,3, Kevin B Laupland3,4, Marlies Ostermann5
1Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Blood purification
|April 16, 2024
概括
在接受连续置换疗法 (CRRT) 的重症患者中,正流体平衡 (FB) 与更糟糕的结果有关. 大多数患者实现了负FB,由净超过驱动,但72小时后的积极FB表明死亡风险更高.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 重症监护病房 (ICU) 的管理人员.
背景情况:
- 在接受连续脏替代疗法 (CRRT) 的重症患者中,正流体平衡 (FB) 与不良结果有关.
- 目前在CRRT患者中使用的FB管理策略尚不清楚.
- 这项研究旨在调查英国和澳大利亚ICU的CRRT患者的FB及其组件.
研究的目的:
- 分析接受连续脏替代疗法 (CRRT) 的重症患者的液体平衡 (FB) 和其贡献因素.
- 确定具有阳性FB的CRRT患者的特征和结果.
- 为未来针对CRRT流体管理的临床试验的设计提供信息.
主要方法:
- 追溯分析来自英国和澳大利亚的三个三级重症监护室的电子健康记录.
- 包括接受CRRT的1616名患者.
- 收集CRRT的前7天的每小时流体相关变量和累计FB.
主要成果:
- 平均累积FB在31小时内变为负值,并在7天后达到4.1L的最低点.
- 净超过 (NUF) 是负FB的主要驱动因素,但尿液输出,晶体物施用和营养输入也起到了作用.
- 72小时的阳性FB独立地与增加的医院死亡率 (OR 1.70,p=0.004) 相关,并与更严重的疾病严重程度和血管压缩剂使用有关.
结论:
- 在研究的ICU中,大多数CRRT患者取得了负面的FB,主要受到NUF的影响.
- 在CRRT患者中,72小时的阳性FB与更高的疾病严重程度和血液动力学不稳定性相关.
- 针对CRRT患者早期阴性FB的试验建立均衡可能是具有挑战性的,因为观察到的患者特征和结果.
相关概念视频
Dialysis
307
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
307
Acute Respiratory Failure-V
136
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
136
Parentral Nutrition: Centeral and Peripheral Parental Nutrition
150
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
150
Heart Failure Drugs: Diuretics
370
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
370
Factors Affecting Renal Clearance: Renal Impairment
91
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
91
Regulation of Water Intake
499
Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
499


