Professional Documents
Culture Documents
Dialysis in Critically Ill
Dialysis in Critically Ill
Critically
Fellow’s conference
Ill
Cheryl Pirozzi, MD
February 15, 2012
www.pyroenergen.com/.../dialysis-treatment.jpg
Outline
AKI in the ICU
Principles of RRT
Modes of RRT
Indications for RRT
Optimal timing: When to start and stop
Optimal modality: When to use what
Optimal dosing
RRT in specific clinical situations
Conclusions
AKI in the ICU
Vanholder et al. Pro/con debate: Continuous vs intermittent dialysis for acute kidney injury. Critical
Care 2011, 15:204
Pro-continuous RRT
? Theoretical advantage of more hemodynamic
stability allowing more adequate fluid removal
Metaanalysis of 15 RCTs (Rabindranath Cochrane Rev
2007, 3): no difference between CRRT and IRRT in
haemodynamic instability or hypotension / escalation
of pressors, or mortality or RRT independence.
Patients on CRRT had significantly higher MAP
However most trials excluded pts with major
hemodynamic issues
Some RCTs (but not all) show more negative fluid
balances with CRRT vs IRRT
Up To Date.com
The role of RRT in different
clinical situations
Sepsis and MODS
Congestive heart failure
•Uchino JAMA 2005; 294:813-818.
•Miller's Anesthesia, 7th ed. 2009