Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
4.8 - Renal Replacement Therapy in Critical Care
from Section 4 - Therapeutic Interventions and Organ Support
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Conventional indications for renal replacement therapy (RRT) are refractory hyperkalaemia, refractory metabolic acidosis, pulmonary oedema, uraemia and sustained oliguria or anuria with fluid overload.
2. Two major principles of RRT are diffusion and convection.
3. Intermittent haemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT) and continuous renal replacement therapy (CRRT) are commonly used in intensive care units. These modalities differ in regard to the duration of therapy and blood flow rate, hence the rapidity of solute and fluid removal. They are used to supplement one another according to each patient’s status and clinical settings.
4. When prescribing CRRT, the modality, vascular access, blood flow rate, dose, anticoagulation, target fluid balance and fluid composition should be considered.
5. RRT-related complications, such as vascular access complications, hypotension and electrolyte imbalances, should be frequently monitored, prevented and appropriately managed.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 500 - 509Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Barbar, SD, Clere-Jehl, R, Bourredjem, A, et al. Timing of renal replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med 2018;379:1431.CrossRefGoogle ScholarPubMed
Bellomo, R, Ronco, C, Mehta, RL, et al. Acute kidney injury in the intensive care unit: from injury to recovery: reports from the 5th Paris International Conference. Ann Intensive Care 2017;7:49.CrossRefGoogle ScholarPubMed
Gaudry, S, Hajage, D, Schortgen, F, et al. Initiation strategies for renal replacement therapy in intensive care units. N Engl J Med 2016;375:122–33.CrossRefGoogle Scholar
RENAL Replacement Therapy Study Investigators; Bellomo, R, Cass, A, Cole, L, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627–38.Google ScholarPubMed
VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7–20.CrossRefGoogle Scholar
Zarbock, A, Kellum, JA, Schmidt, C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN Randomized Clinical Trial. JAMA 2016;315:2190–9.CrossRefGoogle ScholarPubMed