DOSING CRRT

Yaron Bar-Lavie M.D.

Chairman Division of Critical Care Medicine
Rambam Medical Center, Haifa
 Blood Post
Flow Dilution

Effluent Pre
dilution

Citrate
Heparin
Calcium
 CRRT Techniques
• SCUF - no fluid added
• CVVH – Just Fluid added (pre or post - filter)
• CVVHD – just Dialysate
• CVVHDF – Dialysate + Fluids
ULTRAFILTRATION
DIALYSIS
ULTRAFILTRATION
+ DIALYSIS
How fluids &solutes move across membranes
• Osmosis
• Diffusion
• Bulk flow (or Mass Flow)
• Convection
Which Gradients exist?
• Concentration
• Pressure
• Electrical
• Membrane adhesion = adsorption
Osmosis
Diffusion
Reverse Osmosis
Reverse Osmosis
Bulk Flow

Independent
of solute
concentration
- to a point
Bulk Flow
Bulk Flow
Adsorption
 What is the Sieving Coefficient?
• Permeability level of the membrane to any solute

S = [F] / [(A+V)/2) = [2*F] / [A+V]

Range = 0-1
 What is CRRT DOSE
• How much effluent is produced
• Effluent = (‫)נוזל צהוב‬
• Pre Dilution
• Post Dilution
• Net Fluid Removal = negative balance
• Dialysis fluid
What is Changed by Dose ?
• Solute Removal
• Bulk Flow
• Diffusion across gradients
Conclusion – How to Dose???
• Indication – Renal Failure +/- Sepsis, Fluid removal
• Pre or Post Dilution or Both
• Dialysis needed?
• Net Balance target
• Safe total Effluent volume = 30-40 cc / Kg / Hour
• For a 70 Kg Pt = 2-3 Liter / hour
• 2 liter Pre + 1 liter Post dilution