重症监护病房中的置换疗法模式和技术:一项国际调查
Céline Monard1, Arnaud Marel2, Michael Joannidis3
1Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France.
Journal of critical care
|April 3, 2025
概括
需要置换疗法 (RRT) 的重症患者在全球表现出不同的治疗偏好. 这项调查强调了持续 (CRRT) 和间歇 (IHD) 血液透析的多样化使用,表明需要进行试验以优化RRT以获得更好的患者结果.
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
- 临床实践 临床实践
背景情况:
- 置换疗法 (RRT) 对高达14%的重症患者至关重要.
- 关于不同RRT方式 (间歇性血液透析[IHD]与持续性置换疗法[CRRT]) 和技术对患者结果的影响的研究有限.
- 了解当前的RRT实践和偏好对于指导未来的研究和临床决策至关重要.
研究的目的:
- 调查重症监护病房 (ICU) 中RRT模式和技术的全球可用性,设置和临床医生偏好.
- 识别间歇性血液透析 (IHD) 和各种连续替代疗法 (CRRT) 技术的使用变异,包括连续静脉静脉透析 (CVVHD),连续静脉静脉血过 (CVVH) 和连续静脉静脉血过 (CVVHDF).
主要方法:
- 在ICU临床医生中进行了一项开放的在线31个问题的全球调查.
- 数据是在2021年7月至2022年3月期间从全球密集型医疗队伍中收集的.
主要成果:
- 来自73个国家的1174名参与者中,有94%的人可以启动RRT. CRRT (97%) 比IHD (85%) 更容易获得.
- 持续静脉血液过 (CVVHDF) 是最常见的CRRT技术 (59%),其次是CVVHD (26%) 和CVVH (16%). 70%的人可以使用至少两种CRRT技术.
- 临床医生对IHD与CRRT的偏好因临床情景而异;CVVHD受益于小分子清除,CVVH受益于败血性休克和液体过载. 技术设置显示出显著的异质性.
结论:
- 这项国际调查揭示了全球RRT实践的巨大多样性,以及强化治疗师的信仰和偏好中的显著异质性.
- 这些发现强调,迫切需要进行强大的比较试验,以确定针对特定临床情况的最佳RRT模式和技术.
- 标准化RRT协议和进一步的研究是必要的,以改善需要支持的重症患者的治疗结果.
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