在资源有限的 PICU 中启动持续置换疗法 (CRRT) 计划:对挑战和结果的回顾性分析
Jerin C Sekhar1, Karthi Nallasamy2, Muralidharan Jayashree1
1Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
BMC nephrology
|July 14, 2025
概括
在资源较少的环境中启动连续脏置换疗法 (CRRT) 是可行的,只要有专门的团队和外部支持. 在CRRT启动时的超乳酸血症预测了重症儿童的死亡率,强调了内部可持续性的需要.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 腎臟病學 (nephrology) 是一種醫學.
- 全球健康 全球健康
背景情况:
- 连续脏替代疗法 (CRRT) 对于严重病症儿童的器官支持至关重要.
- 低收入和中等收入国家 (LMICs) 面临着建立CRRT计划的重大障碍,包括资源限制,技术支持,成本和行政障碍.
研究的目的:
- 评估启动和维持CRRT计划的可行性,挑战和结果在LMIC的三级护理儿科重症监护室 (PICU).
- 为了确定接受CRRT的儿童死亡率的预测因素.
主要方法:
- 在2019年2月至2023年5月期间,52名儿童接受了71次CRRT治疗.
- 分析CRRT指示,处方细节,并发症和存活到出院的时间.
- 调查了诸如SARS-CoV-2流行病,技术支持和资金以及克服这些挑战的策略等挑战.
主要成果:
- 对于CRRT的常见症状包括急性损伤 (53.8%) 和高氨血症 (21.2%).
- 连续毒静脉血液过是主要的方法. 过器凝血 (33.8%) 和接入流量问题 (7%) 是主要的并发症.
- 排放后的生存率为25%. 在CRRT开始时的高乳糖血症 (血清乳酸≥3 mmol/L) 独立预测死亡率 (aOR6.1,P=0.04).
结论:
- 通过专门的,训练有素的团队和外部资源动员,在LMICs建立CRRT计划是可以实现的.
- 可持续性取决于开发内部的技术和财务支持.
- 超乳糖血是这一群体死亡率的关键预测因素,强调了早期干预的必要性.
相关概念视频
01:30Continuous Renal Replacement Therapy
152
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
152
01:20Acute Kidney Injury V: Interprofessional Care
46
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
46
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
318
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,...
318
01:28Chronic Kidney Disease III: Interprofessional Care
81
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
81
01:22Acute Kidney Injury I: Introduction
80
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
80
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
58
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
58