儿童患者的区域酸抗凝剂:处理实践要点
Zaccaria Ricci1,2, Akash Deep3, Stuart L Goldstein4
1Department of Emergency and Critical Care, Anesthesia and Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy, zaccaria.ricci@unifi.it.
Blood purification
|October 3, 2025
概括
区域酸盐抗凝药 (RCA) 在儿科连续脏替代疗法 (CRRT) 中是安全的. 仔细考虑酸盐度和患者因素对于儿童安全有效的RCA至关重要.
科学领域:
- 儿科脏病学 儿科脏病学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 区域酸盐抗凝药 (RCA) 是成人和儿科患者持续置换疗法 (CRRT) 的安全有效方法.
- 同样的设备和解决方案用于儿科和成人CRRT的RCA.
- 由于对CRRT参数的潜在影响,了解儿科RCA的细微差别至关重要.
研究的目的:
- 在儿科环境中审查RCA的实践概念.
- 突出酸盐度的重要性及其对儿童CRRT参数的影响.
- 为临床医生提供详细的知识,以便在儿科患者中接近RCA.
主要方法:
- 对CRRT中RCA的可用文献和商业酸盐配方的审查.
- 分析不同酸盐度对CRRT剂量,过率,电路压力和流体流量的影响.
- 讨论在给儿童处方RCA时需要考虑的因素,包括酸盐剂量,负载,度和患者的新陈代谢.
主要成果:
- 有三种商业酸盐配方用于RCA:缩 (4%),半缩 (ACD-A,75 mmol/L) 和稀释 (18 mmol/L).
- 预稀释RCA输液的量会影响CRRT剂量,过率,电路压力和流体流量,在较小的患者中更为重要.
- 不同的酸盐配方导致给定酸盐剂量和血液流速的CRRT设置,负荷,过分数和透析剂量的变化.
结论:
- 选择酸盐配方显著影响儿童患者的CRRT输送.
- 临床医生必须仔细考虑血流量,酸盐剂量,负载,度和患者的代谢能力.
- 根据可用的酸盐度对RCA处方进行上下文化对于优化儿科CRRT的结果至关重要.
相关概念视频
01:29Venous Thrombosis III: Interprofessional Care
280
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
280
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
750
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,...
750
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
1.2K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
1.2K
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
212
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
212
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
252
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
252
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
242
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
242