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重症监护室连续替代疗法:改变剂量建议的时间?
1Department of Internal Medicine IV, University Hospital Munich, Ziemssenstr.3, D 80336, Munich, Germany. h-schiffl@t-online.de.
International urology and nephrology
|October 17, 2024
概括
持续置换疗法 (CKRT) 剂量对于患有急性损伤 (AKI) 的重症患者至关重要. 研究表明,较低的CKRT剂量,如在日本见到的,可能会增加死亡率,突出需要最佳的剂量策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 密集护理医学 密集护理医学
- 关键的护理关键的护理
背景情况:
- 持续置换疗法 (CKRT) 对血液动力学不稳定的重症监护室患者,患有严重急性损伤 (AKI) 至关重要.
- CKRT的有效性取决于输送的剂量,目前的KDIGO指南建议20-25毫升/公斤/小时,对某些患者可能更高.
- 在全球范围内,CKRT剂量的实践模式是高度可变的,需要对治疗充足性的更清晰的理解.
研究的目的:
- 调查重症患者中CKRT剂量的临床相关性.
- 确定防止伤害的最小有效CKRT剂量,特别是在特定患者群体中,如肥胖或COVID-19患者.
- 为满足未满足的未来试验需求,确定最佳CKRT强度.
主要方法:
- 审查目前的KDIGO指导方针和关于CKRT剂量的里程碑性试验.
- 分析日本ICU接受CKRT治疗严重AKI的患者的数据,并指出传递剂量的中位数.
- 考虑追溯队列研究的发现,如Okamoto等,将低剂量的CKRT与增加的死亡率联系起来.
主要成果:
- 里程碑式的试验表明,在未经选择的AKI患者中,超过推的CKRT剂量没有益处.
- 日本的ICU患者通常接受的CKRT剂量低于KDIGO建议 (中位数为15毫升/公斤/小时).
- 一项回顾性研究将较低的CKRT剂量与重症AKI患者的较高死亡率联系在一起,挑战了低于20毫升/公斤/小时的剂量的充足性.
结论:
- 有必要进行前性随机试验,以确定最小有效的CKRT剂量.
- 应根据KDIGO指导方针对CKRT剂量进行个性化,并考虑患者特定的因素.
- 日本对低剂量CKRT的经验并没有改变目前改变实践的建议,但强调了适当剂量的重要性.
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