Audit of enteral nutrition provision during citrate anticoagulation of continuous renal replacement therapy in the intensive care units

2018 ◽  
Vol 28 ◽  
pp. 267-268
Author(s):  
L. Rose ◽  
E. Cresta ◽  
C. Day ◽  
F. Dakpoe ◽  
J. O’Flynn ◽  
...  
2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.


2014 ◽  
Vol 23 (4) ◽  
pp. 348-351 ◽  
Author(s):  
Cherylynn A. Brownback ◽  
Patricia Fletcher ◽  
Lynelle N. B. Pierce ◽  
Susan Klaus

Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies.


2016 ◽  
Vol 18 (1) ◽  
pp. 47-51
Author(s):  
Samina R Chowdhury ◽  
Tom Lawton ◽  
Aaqid Akram ◽  
Robert Collin ◽  
James Beck

Continuous renal replacement therapy necessitates the use of anticoagulation. The anticoagulant of choice has traditionally been heparin. Emerging evidence has highlighted the deleterious effects of systemic heparin anticoagulation in the critically ill. Regional citrate anticoagulation has been used as an alternative in the setting of continuous renal replacement therapy. Our retrospective before-and-after cohort study aimed to ascertain if regional citrate anticoagulation is associated with any benefit in terms of circuit longevity, rates of complications, blood transfusion requirements and mortality, when introduced to a large general intensive care unit with a case mix of acute medical patients and acute and elective surgical patients. The switch to regional citrate anticoagulation for continuous renal replacement therapy in our intensive care unit has been associated with a dramatically longer circuit life, with major implications for cost savings in terms of reduced nursing workload. We hope to look at fiscal aspects of the change in protocol in greater depth.


2011 ◽  
Vol 150 (2) ◽  
pp. 233-235
Author(s):  
Cristina Giglioli ◽  
Valentina Spini ◽  
Daniele Landi ◽  
Alessio Mattesini ◽  
Serafina Valente ◽  
...  

2021 ◽  
Author(s):  
Elodie Matusik ◽  
Justine Lemtiri ◽  
Guillaume Wabont ◽  
Fabien Lambiotte

Abstract BackgroundLittle information is available on current practice in beta-lactam dosing during continuous renal replacement therapy (CRRT). Optimized dosing is essential for improving outcomes, and there is no consensus on the appropriate dose regimens. The objective of the present study was to describe current practice for beta-lactam dosing during CRRT in intensive care units (ICUs).MethodsWe conducted a nationwide survey by e-mailing an online questionnaire to physicians working in ICUs in France. The questionnaire included three sections: demographic characteristics, CRRT practices, and beta-lactam dosing regimens during CRRT.Results157 intensivists completed the questionnaire. Continuous venovenous hemofiltration was the most frequently used CRRT technique, and citrate was the most regularly used anticoagulant. The median prescribed dose at baseline was 30 mL/kg/h. The majority of prescribers (57%) did not reduce beta-lactam dosing during CRRT. The tools were used to adapt dosing regimens during CRRT included guidelines, therapeutic drug monitoring (TDM), and data from the literature. When TDM was used, 100% T > 4 time the MIC was the most common mentioned pharmacokinetic/pharmacodynamic target (53%). Pharmacokinetic software tools were rarely used. Prolonged or continuous infusions were widely used during CRRT (88%). Institutional guidelines on beta-lactam dosing during CRRT were rare. 41% of physicians sometimes consulted another specialist before adapting the dose of antibiotic during CRRT.ConclusionsOur present results highlight the wide range of beta-lactam dosing practices adopted during CRRT. Personalized TDM and the implementation of Bayesian software appear to be essential for optimizing beta-lactam dosing regimens and improving patient outcomes.


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