scholarly journals Emergency Continuous Peritoneal Dialysis using Flexible Tenckhoff Catheter inserted with Reinforced Purse String Suture : An efficient substitute of renal replacement therapy in Critically Ill Patients with AKI when Intermittent Hemodialysis, Sustained lo

2016 ◽  
Vol 4 (1) ◽  
pp. 3-8
Author(s):  
Sarwar Iqbal ◽  
Tufayel Ahmed Chowdhury ◽  
Mohammad Omar Faruq ◽  
ASM Manzur Morshed Bhuiyan ◽  
Mehruba Alam Ananna ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Intermittent Hemodialysis ◽  
Mechanical Ventilator ◽  
Purse String ◽  
Tenckhoff Catheter

Introduction : Renal replacement therapy (RRT) is often used to treat critically ill patients associated with acute or chronic renal failure. Peritoneal dialysis (PD) is an option when intermittent hemodialysis (IHD), sustained low efficiency dialysis (SLED) or Continuous renal replacement therapy (CRRT) are not feasible. PD customarily uses rigid catheter and cannot be used for more than 3 days as there is increased chance of infection and it can cause perforation of hollow viscera and often there is hemorrhage due to trauma to the adjacent organs. In this study we used Tenckhoff flexible PD catheter with double cuff and reinforced purse string suture1, So it can be used on an emergency basis and for indefinite period with minimal chances of complications commonly associated with rigid PD catheter. In this observational study emergency CPD using the procedure mentioned above in a compromised group of renal insufficiency patients was explored.Objectives : To determine if emergency RRT can be achieved by CPD using flexible Tenckhoff catheter placed with special reinforced sutures when IHD, SLED or CRRT is not feasible in critically ill patients.Material and Methods : Patients who failed to tolerate IHD, SLED or CRRT because of resulting hemodynamic instability and those who required dialysis urgently and for a prolonged period in Intensive Care Unit (ICU) were selected. There were 58 study cases who received emergency CPD after fulfilling inclusion criteria using flexible Tenckhoff catheter placed with special reinforced suture. These patients were on various life-support modalities having multiple co-morbidities. Regular exchanges were started manually with small volume on the day or the next day of catheter implantation, initially with 0.5-1 liter/session and subsequently with 2 liters per session after 15 days. Serum creatinine of study subjects were followed for 45 days and study subjects were followed for up to a year to check for survivability.Results : In 58 critically ill cases that fulfilled the criteria were included in the study. Average age was 67.05±14.43 years and 66% were male. Majority were diabetic 48 (82.75%) and the cause of AKI were sepsis in 39 cases (67.2%) acute cardiovascular insufficiency in 9 cases (AMI & NSTEMI 15.5%), gastroenteritis in 3 cases (5.2%), stroke in 4 cases (6.9%) and multi organ failure in 7 cases (12.1%). Average creatinine at the initiation of dialysis was 7.68 ± 3.15 and after 5 days it was 5.86± 2.8, after 10 days 4.08 ± 2.61, after 15 days 2.87 ± 2.1, one month 2.32± 1.90 and after one and a half months 2.31± 1.88. Volume overload was the indication of CPD in 22 (37.93%) patients but main indication was uremia in 36 (62.06%) cases. In ICU 23 (39.7%) patients expired within a short (within 7 days) period. In the remaining 30(42.9%) survived beyond 4 weeks (51.7); 22 (37.9%) beyond 12 weeks; 14(24.1%) beyond 24 weeks and 5(8.6)% beyond 1 year. In 4 (2.32%) patients PD catheter was removed as renal function improved. 35 patients were on mechanical ventilator and out of them 18 patients were weaned of mechanical ventilator (MV). 26 MV patents (including weaned off) survived beyond 4 weeks. Mechanical complications from PD catheter in situ were very low and there was catheter related infection only in two cases.Conclusion : Emergency CPD can be an alternate mode of renal replacement therapy (RRT) in critically ill patients where emergency IHD, SLED or CRRT are not feasible. It was accompanied with low risk of procedure related complications and well tolerated.Bangladesh Crit Care J March 2016; 4 (1): 3-8

scholarly journals Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update

2019 ◽  
Vol 54 (1) ◽  
pp. 43-55 ◽  
Author(s):  
Brian M. Hoff ◽  
Jenana H. Maker ◽  
William E. Dager ◽  
Brett H. Heintz
Keyword(s):  
Renal Function ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Response To Therapy ◽  
Intermittent Hemodialysis ◽  
Intermittent Renal Replacement Therapy ◽  
Antibiotic Dosing

Objective: To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy (CRRT), including considerations for individualizing therapy. Data Sources: A literature search of PubMed from January 2008 to May 2019 was performed to identify English-language literature in which dosing recommendations were proposed for antibiotics commonly used in critically ill patients receiving IHD, PIRRT, or CRRT. Study Selection and Data Extraction: All pertinent reviews, selected studies, and references were evaluated to ensure appropriateness for inclusion. Data Synthesis: Updated empirical dosing considerations are proposed for antibiotics in critically ill patients receiving IHD, PIRRT, and CRRT with recommendations for individualizing therapy. Relevance to Patient Care and Clinical Practice: This review defines principles for assessing renal function, identifies RRT system properties affecting drug clearance and drug properties affecting clearance during RRT, outlines pharmacokinetic and pharmacodynamic dosing considerations, reviews pertinent updates in the literature, develops updated empirical dosing recommendations, and highlights important factors for individualizing therapy in critically ill patients. Conclusions: Appropriate antimicrobial selection and dosing are vital to improve clinical outcomes. Dosing recommendations should be applied cautiously with efforts to consider local epidemiology and resistance patterns, antibiotic dosing and infusion strategies, renal replacement modalities, patient-specific considerations, severity of illness, residual renal function, comorbidities, and patient response to therapy. Recommendations provided herein are intended to serve as a guide in developing and revising therapy plans individualized to meet a patient’s needs.

scholarly journals Drug Dosing Considerations in Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 18 ◽  
Author(s):  
Soo Min Jang ◽  
Sergio Infante ◽  
Amir Abdi Pour
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Patient Specific ◽  
Therapeutic Drug ◽  
Intermittent Hemodialysis ◽  
Drug Dosing ◽  
Low Efficiency

Acute kidney injury is very common in critically ill patients requiring renal replacement therapy. Despite the advancement in medicine, the mortality rate from septic shock can be as high as 60%. This manuscript describes drug-dosing considerations and challenges for clinicians. For instance, drugs’ pharmacokinetic changes (e.g., decreased protein binding and increased volume of distribution) and drug property changes in critical illness affecting solute or drug clearance during renal replacement therapy. Moreover, different types of renal replacement therapy (intermittent hemodialysis, prolonged intermittent renal replacement therapy or sustained low-efficiency dialysis, and continuous renal replacement therapy) are discussed to describe how to optimize the drug administration strategies. With updated literature, pharmacodynamic targets and empirical dosing recommendations for commonly used antibiotics in critically ill patients receiving continuous renal replacement therapy are outlined. It is vital to utilize local epidemiology and resistance patterns to select appropriate antibiotics to optimize clinical outcomes. Therapeutic drug monitoring should be used, when possible. This review should be used as a guide to develop a patient-specific antibiotic therapy plan.

Continuous Renal Replacement Therapy for Critically Ill Patients: An Update

1994 ◽  
Vol 9 (6) ◽  
pp. 265-280 ◽  
Author(s):  
Eric F. H. van Bommel ◽  
Karel M. L. Leunissen ◽  
Willem Weimar
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Clinical Aspects ◽  
Intermittent Hemodialysis ◽  
Organ Systems

van Bommel EFH, Leunissen KML, Weimar W. Continuous renal replacement therapy for critically ill patients: an update. J Intensive Care Med 1994; 9: 265–280. Despite continuous progress in intensive care during the last decades, the outcome of critically ill patients in whom acute renal failure (ARF) develops is still poor. This outcome may be explained partially by the frequent occurrence of ARF as part of multiple organ systems failure (MOSF). In this complex and unstable patient population, the provision of adequate renal support with either intermittent hemodialysis or peritoneal dialysis may pose major problems. Continuous renal replacement therapy (CRRT) is now increasingly accepted as the preferred treatment modality in the management of ARF in these patients. The technique offers adequate control of biochemistry and fluid balance in hemodynamically unstable patients, thereby enabling aggressive nutritional and inotropic support without the risk of exacerbating azotemia or fluid overload. In addition, experimental and clinical data suggest that CRRT may have a beneficial influence on hemodynamics and gas exchange in patients with septic shock and (nonrenal) MOSF, independent of an impact on fluid balance. We review both technical and clinical aspects of various continuous therapies, including their impact on serum drug levels and nutrient balance. In addition, an attempt is made to clarify the possible beneficial role of CRRT in reducing patient morbidity and mortality in the ICU.

scholarly journals Hemodynamic Tolerability of Sustained Low Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury

2017 ◽  
Vol 6 (2) ◽  
pp. 84-90
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq ◽  
Md Mozammel Hoque ◽  
ASM Areef Ahsan ◽  
Parvin Akter Khanam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

Background: Sustained low efficiency dialysis (SLED) has been evolved in recent years as technical hybrid of continuous renal replacement therapy and intermittent hemodialysis. It offers optimized hemodynamic stability of the critically ill patients with acute kidney injury (AKI). Our aim was to evaluate the hemodynamic tolerability of SLED in hemodynamically unstable patients with AKI.Methods: This prospective experimental study was conducted in Intensive Care Unit of BIRDEM General Hospital, Dhaka over a period of one year.Results: Forty three hemodynamically unstable patients with AKI were treated with one fifty three sessions of SLED. Mean arterial pressure of the patients before starting dialysis were 80.58±10.92 mmHg and 69.8% patients were on inotrope support. There were no significant differences (p>0.05) in mean arterial pressure during the procedure. No significant changes (p>0.05) occurred in pulse, respiratory rate and temperature during the sessions. Only thirty six out of 153 SLED sessions were associated with complications and hypotension was the commonest one (20.26%). Hypotensive episodes were effectively managed with addition or dose escalation of inotropes. No dialysis had to be discontinued because of hypotension/arrhythmia.Conclusion: SLED is an effective renal replacement therapy for the critically ill patients with AKI which maintains their hemodynamic stability.Birdem Med J 2016; 6(2): 84-90

Renal replacement therapy in critical care: implementation of a unit-based continuous venovenous hemodialysis program

1998 ◽  
Vol 18 (1) ◽  
pp. 40-51 ◽  
Author(s):  
KK Giuliano ◽  
EE Pysznik
Keyword(s):  
Renal Failure ◽  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intermittent Hemodialysis ◽  
Staff Support ◽  
Successful Program ◽  
Continuous Venovenous Hemodialysis

Implementing a program as complex as continuous venovenous hemodialysis without the involvement of nephrology nurses is a challenge. However, with proper planning, appropriate staff support, and the ability to make changes as implementation proceeds, a successful program can be developed. Our reward is that we are now able to offer a therapy that is important and potentially lifesaving to those critically ill patients with renal failure who are unable to tolerate intermittent hemodialysis.

scholarly journals 1298. Population Pharmacokinetics of Ceftazidime-avibactam among Critically-ill Patients with and without Receipt of Continuous Renal Replacement Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S663-S664
Author(s):  
Ellen G Kline ◽  
Minh Hong T Nguyen ◽  
Erin K McCreary ◽  
Brett Wildfeuer ◽  
Josh Kohl ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Panel Member ◽  
Pharmacokinetic Parameters ◽  
Intermittent Hemodialysis ◽  
Review Panel ◽  
Research Grant

Abstract Background Ceftazidime-avibactam (CAZ-AVI) is used to treat multidrug-resistant infections. There are limited pharmacokinetic (PK) data among critically-ill patients (pts) and no dosing recommendations for those receiving continuous renal replacement therapy (CRRT). Methods We conducted a PK study of CAZ-AVI among pts with and without CRRT. Serial blood samples were collected at 0 (pre-dose), 2, 4, 6, and 8 hours after CAZ-AVI administration. All doses were infused over 2h. Samples were centrifuged and plasma stored at -80°C until analysis by a Shimadzu Nexera XD UHPLC with a Shimadzu 8045 MS. Transitions were monitored in positive mode for CAZ (m/z 274.05 < 80.05) and negative mode for AVI (264.00 < 95.90). The assay was reproducible and linear over a range of 0.1 – 20 µg/mL for AVI and 1 – 200 µg/mL for CAZ. non-compartmental analyses were used. Results 96 plasma samples from 20 pts were included in the study. Median age was 56 years (range: 31 – 74), 55% were male, and 90% were in the ICU at the time of collection. CZA dosing regimens included 2.5g IV q 8h (n=15), 1.25g IV q 8h (n=2), 0.94g IV q 24h (n=1), and 0.94g IV q 48h (n=2). 7 pts received CRRT (median blood and dialysate flow rates were 250 mL/min and 2.5 L/h, respectively; 86% received 2.5g IV q 8h) and 2 pts received intermittent hemodialysis (iHD). Among remaining pts, median creatinine clearance (CrCl) by Cockcroft-Gault was 91ml/min (range: 37 – 168 ml/min). PK values for CAZ and AVI are shown in the Table. Individual concentration-time profiles for patients receiving 2.5g IV q 8h are shown in the Figure. For patients receiving 2.5g IV q8h, CAZ and AVI median (IQR) AUCs were 525.6 hr*µg/ml (403.2, 762.0) and 83.7 (57.3, 129.5), respectively. For those on CRRT receiving the same dose, CAZ and AVI median (IQR) AUCs were 450.2 (450.0, 558.4) and 102.4 (100.7, 142.3), respectively. CAZ pharmacodynamics (PD) targets of 100% fT > 1x and 4x MIC were achieved in 90% and 55% of pts, respectively. AVI PD targets of 100% fT > 1 and 2.5µg/mL were achieved in 100% and 80% of pts, respectively. Treatment-emergent adverse events were not reported in any case. Ceftazidime and avibactam pharmacokinetic parameters among critically-ill patients Conclusion Among this cohort of critically-ill pts, CAZ and AVI exposures varied; however, most pts achieved PD targeted exposures, including those patients receiving CRRT and a standard dosing regimen of 2.5g IV q 8h. Disclosures Erin K. McCreary, PharmD, Entasis (Advisor or Review Panel member)Summit (Advisor or Review Panel member) Ryan K. Shields, PharmD, MS, Allergan (Advisor or Review Panel member, Research Grant or Support)Entasis (Advisor or Review Panel member)Melinta (Research Grant or Support)Menarini (Consultant)Merck (Advisor or Review Panel member, Research Grant or Support)Shionogi (Advisor or Review Panel member, Research Grant or Support)Summit (Advisor or Review Panel member)Tetraphase (Research Grant or Support)Venatorx (Advisor or Review Panel member, Research Grant or Support)

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