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Ebook Critical care (6/E): Part 2

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Nội dung chi tiết: Ebook Critical care (6/E): Part 2

Ebook Critical care (6/E): Part 2

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2replacement therapy? Indications can be grouped by using the AEIOU mnemonic:A: Acidosis (Metabolic): Refractory to bicarbonate administration. E: Elec

trolyte imbalances: Hyperkalemia refractory to medical therapy is the most common. I: Ingestions: Some drugs and toxins (and their toxic metabolites) Ebook Critical care (6/E): Part 2

can be cleared with dialysis, including aspirin, lithium, methanol, or ethylene glycol. A drug’s dialyzability is dependent on many factors, including

Ebook Critical care (6/E): Part 2

size, water solubility, and volume of distribution.0: Overload (Volume): Ultrafiltration (volume removal) with dialysis can relieve hypoxemia resulti

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2l dysfunction. Symptoms and signs of uremia can range from mild (anorexia, nausea, pruritus) to severe (encephalopathy, asterixis, pericarditis); pati

ents may also have clinical platelet dysfunction (bleeding) due to uremia.2List the different modes of renal replacement therapy.Intermittent renal re Ebook Critical care (6/E): Part 2

placement therapies:•Intermittent hemodialysis (IHD)•Pure ultrafiltration (PUF): Fluid removal without convective or diffusive clearance•Hybrid therap

Ebook Critical care (6/E): Part 2

ies: Sustained low-efficiency (daily) dialysis (SLED)/Prolonged intermittent renal replacement therapy (PIRRT)•Sustained low-efficiency diafiltration

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2inuous ultrafiltration (SCUF): Fluid removal without convective or diffusive clearance•Continuous venovenous hemofiltration (CWH)•Continuous venovenou

s hemodialysis (CWHD)•Continuous venovenous hemodiafiltration (CWHDF)3What are hybrid therapies?This term refers to recently developed hybrid modes of Ebook Critical care (6/E): Part 2

dialysis that fall under the broader term PIRRT or SLED. Dialysis can be delivered through a variety of conventional IHD machines (an advantage over

Ebook Critical care (6/E): Part 2

CRRT), usually with some minor modifications to allow for slower dialysate flow rates compared with IHD. Therapy is delivered intermittently but over

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2y of the benefits of CRRT (e.g., more gentle fluid shifts and therefore better hemodynamic stability) without some of the disadvantages (see Question

5).4When should continuous renal replacement therapies or hybrid therapy be considered?CRRT or hybrid therapy should be considered in any critically i Ebook Critical care (6/E): Part 2

ll patient with an indication for dialysis. CRRT or hvbrid modalities tend to be better tolerated hemodvnamicallv than intermittent dialvsis308 RENAL

Ebook Critical care (6/E): Part 2

DISEASEhyperphosphatemia. Oftentimes, CRRT or hybrid modalities that utilize slower fluid rates are preferred in patients with increased intracranial

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2evere, lifethreatening hyperkalemia and most ingestions (e.g., ethylene glycol) because clearance per unit time is faster with IHD compared with CRRT.

5What are some disadvantages of continuous renal replacement therapies?Because of its continuous nature, CRRT requires long-term relative immobilizati Ebook Critical care (6/E): Part 2

on of the patient, which can increase the risk for venous thromboembolism, pressure ulcers, and physical deconditioning. Continuous anticoagulation ma

Ebook Critical care (6/E): Part 2

y be necessary to prevent filter clotting and subsequent blood loss, and this may increase the bleeding risk. CRRT frequently results in hypothermia,

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2bor intensive, typically requiring 1:1 nursing, and therefore costly.6Define hemofiltration, hemodialysis, and hemodiafiltration.•Hemofiltration: Plas

ma is forced from the blood space into the effluent via the application of pressure across a highly permeable membrane. This results in convective cle Ebook Critical care (6/E): Part 2

arance of small and middle-sized molecules through the physical property of solvent drag. This modality does not significantly change the concentratio

Ebook Critical care (6/E): Part 2

n of serum electrolytes and waste products unless a replacement fluid is infused into the blood, effectively diluting out those solutes the physician

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2bicarbonate in a patient with acidemia).•Hemodialysis: Blood flows on one side of a semipermeable membrane, and the dialysate, which contains various

electrolytes, flows along the other side, usually in the opposite (countercurrent) direction. A concentration gradient drives electrolytes and water-s Ebook Critical care (6/E): Part 2

oluble waste products from the plasma compartment into the dialysate. The dialysis machine generates a pressure across the membrane to drive plasma wa

Ebook Critical care (6/E): Part 2

ter from the blood side to the dialysate side. Dialysis results in diffusive clearance, preferentially of small molecules.•Hemodiafiltration: This tec

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

Ebook Critical care (6/E): Part 2 prescription for intermittent hemodialysis and for continuous renal replacement therapies.IHD:

RENAL REPLACEMENT THERAPYAND RHABDOMYOLYSISStephanie Shieh and Kathleen D. LiuCHAPTER 48RENAL REPLACEMENT THERAPY1What are the indications for renal r

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