在重症监护室使用替代疗法的趋势:来自法国多中心队列的见解
Julien Schmidt1, Lamiae Grimaldi2, Patricia Martel2
1Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France.
Intensive care medicine
|November 25, 2025
概括
在急性损伤 (AKI) 患者的重症监护病房 (ICU) 中,替代疗法 (RRT) 的使用在过去十年里有所下降. 这一趋势表明,在重症患者中启动RRT的更保守的策略正在转变.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 流行病学 流行病学
背景情况:
- 从历史上看,早期启动替代疗法 (RRT) 是急性损伤 (AKI) 的标准.
- 最近的临床试验表明,一种保守的方法,延迟RRT启动可能是有益的.
- 了解RRT使用的时间趋势对于评估实践变化至关重要.
研究的目的:
- 评估在12年内被诊断患有AKI的重症监护室 (ICU) 患者中使用RRT的时间趋势.
- 分析随着时间的推移,RRT模式的变化.
- 评估不断变化的临床试验证据对RRT实践的影响.
主要方法:
- 使用CUB-Réa数据库 (2008-2019) 的回顾性队列研究.
- 纳入标准:需要机械通风和 (或) 甲基荷胺输注的AKI的ICU患者.
- 分析包括RRT利用的时间趋势,RRT模式和中断时间序列分析.
主要成果:
- 机动车使用率从39.7% (2008-2011) 降至35.9% (2016-2019) (p < 0.0001).机动车使用率从39.7% (2008-2011) 降至35.9% (2016-2019) (p < 0.0001).机动车使用率从39.7% (2008-2011) 降至35.9% (2016-2019) (p < 0.0001).
- 经过调整后的分析显示,随着时间的推移,RRT使用的下降趋势显著.
- 从基线到2019年,RRT使用的年度原始率下降了20.8%.
结论:
- 在过去的十年中,RRT利用率在重症患者中下降.
- 这种观察到的下降表明,逐渐转向更保守的RRT启动策略.
- 这些发现突显了在ICU中管理AKI的临床实践模式的发展.
相关概念视频
Continuous Renal Replacement Therapy
768
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...
768
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
165
Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
165
Acute Kidney Injury I: Introduction
536
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...
536
Acute Kidney Injury IV: Diagnostic Studies and Prevention
249
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...
249
Acute Kidney Injury V: Interprofessional Care
284
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...
284
Acute Kidney Injury III: Clinical Manifestations
785
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
785


