Blood purification in the critically ill patient. Prescription tailored to the indication (including the pediatric patient)

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• 作者：J.A. Sanchez-Izquierdo Riera^a ; ^{jasiruci@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; R. Montoiro Allué ; ^b ; T. Tomasa Irriguible^c ; E. Palencia Herrejó ; n^d ; F. Cota Delgado^e ; C. Pé ; rez Calvo^f
• 关键词：Extracorporeal purification ; AKI ; Dynamic purification ; Dose and timing of CEBPT ; Non-renal indications ; High volume ; HVHF ; Purification in children
• 刊名：Medicina Intensiva
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：40
• 期：7
• 页码：434-447
• 全文大小：1262 K

文摘

We maintain a dynamic position on extracorporeal blood purification therapies (EBPT). Continuous therapies are of choice in the hemodynamically unstable patient. We recommend their early introduction in the course of the disease, and starting with a dose of 30–35 mL/kg/h. Above all, however, daily re-evaluation is required of the hemodynamic and metabolic situation and water balance of our patients in order to allow dynamic dose adjustment. Some data suggest that continuous EBPT can favorably influence the clinical course of our patients, even in the absence of acute kidney injury. The potential usefulness of hemofiltration at doses higher than the conventional doses (continuous ultrafiltration >50 mL/kg/h or pulses of at least 4 h a day to more than 100 doses mL/kg/h) for achieving blood purification has also been commented. We review the possible indications of this technique, together with the peculiarities of implementing these therapies in children.