Severe acute pancreatitis (SAP) is a serious acute inflammatory disease with complex pathogenesis, rapid progression, high mortality, extensive treatment, and heavy socioeconomic burden, which is often complicated by systemic multiple organ dysfunction. Renal replacement therapy (RRT) is essential for removing inflammatory mediators, cytokines or other toxins, as well as stabilizing the internal environment. Therefore, RRT is utilized as an organ support technology in the clinical management of SAP. Currently, there is no consensus regarding when and under what circumstances RRT can be employed in patients with SAP. In this paper, the pathogenesis of SAP and the indications and timing of initiation of RRT will be discussed.
Objective To explore the feasibility and effect of infusion pump potassium supplementation in continuous renal replacement therapy (CRRT). Methods Patients who underwent CRRT were randomly divided into infusion pump group and traditional way group between March and May 2018. In infusion pump group, 10% potassium chloride was supplemented with infusion pump. In traditional way group, 10% potassium chloride was supplemented in the traditional way, which meant adding potassium in the replacement solution. The peripheral blood potassium level, the potassium well-controlled rate, the incidence of adverse events, the average frequency of replacement liquid bags change, the average pump stopping time, and the delivery dose and potassium supplement dose between the two groups were compared. Results A total of 60 patients were randomly divided into two groups, with 30 cases in each group. The infusion pump group was treated with an average of 6.90 mL/h potassium supplement dose by infusion pump, and in traditional way group, potassium was added to the replacement solution by an average of 9.29 mL/h; there were significant differences between the two groups (P<0.05). When compared with traditional way group, there was no significant differences (P>0.05) in the peripheral blood potassium level and the potassium well-controlled rate of the patients at 0, 2, 8, 12 and 24 hours after CRRT (P>0.05). As for the adverse events rate, average frequency of replacement liquid bags change, average pump stopping time, and potassium supplement dose, there were significant differences between the two groups (P<0.05). Conclusions The application of infusion pump to supply potassium in CRRT is feasible and safe, and is superior to the traditional potassium supplement method. It could be further applied in clinical practice.
Acute kidney injury is a common complication and is associated with multiple organ dysfunction syndrome among critically ill patients in intensive care unit. Once renal replacement therapy in required, the mortality rate was high. Using slow and uninterrupted clearance of retained fluid and toxins, continuous renal replacement therapy (CRRT) can avoid hemodynamic instability while provide acid-base, electrolytes, and volume homeostasis. For decades, CRRT has become the dominant form of renal replacement therapy as well as multiple organ support in critically ill patient with acute kidney injury. However, there remains wide practice variation in the CRRT care when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice, despite evidences to guide practice. In addition, CRRT is a complex technology that is resource-intensive, costly, and requires specialized training by health providers.Taiwan Society of Critical Care Medicine organized a group of experts in critical care and nephrology to review the recommendations and provide their clinical practice and concerns to write this operational manual. The purpose of this manual is to provide step-by-step instructions on the practice of CRRT and troubleshooting. In addition, it is designed to help the newbies to carry out this complex treatment correctly and efficiently. We hope that this operational manual is of value to improve clinical skills, quality of care, and patient safety.
Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.
Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Objective To investigate the effect of continuous renal replacement therapy (CRRT) on rhabdomyolysis with acute kidney injury (AKI) following multiple wasp stings. Methods We designed a prospective study which enrolled 132 patients who developed rhabdomyolysis after multiple wasp stings between January 2013 and December 2016 in Jianyang People’s Hospital, West China Hospital of Sichuan University and Anyue People’s Hospital. Among these, 62 patients with AKI were treated with CRRT. The modality of CRRT was continuous veno-venous hemofiltration (CVVH). CVVH was performed for at least 48 hours by using Prismaflex and M100-AN69 hemofilter. Hemofiltration was accomplished using predilution bicarbonate with the replacement fluid rate of 2 000–2 500 mL/h [30–35 mL/(kg·h)]. Heparin or low-molecular-weight heparin was used for anticoagulation, with blood flow rate of 180–200 mL/min. Then intermittent hemodialysis was performed when patients’ condition became stable. Mortality, kidney recovery, biochemical indicators and length of stay were collected. Results Fifty-one patients met the inclusion criteria finally, and four (7.8%) of them died during hospitalization, and the remaining 47 patients survived with completed treatment and follow-up. At 3, 7, and 14 days after treatment, the creatine kinase, myoglobin and lactate dehydrogenase of the patients all decreased significantly and gradually, and returned to normal level finally. Kidney function was recovered in 45 (95.7%) patients within 3 months, and 2 patients suffered chronic kidney disease. The patients’ hemoglobin recovered to normal level at (30.5±11.3) days. Conclusion Rhabdomyolysis and AKI were severe complications following multiple wasp stings, and early CRRT may bring significant benefits to such patients.
Objective To explore the global research status and trends of continuous renal replacement therapy (CRRT) based on knowledge visualization analysis. Methods Based on the Web of Science Core Collection, studies reporting CRRT research that were published between June 2014 and June 2023 were retrieved and collected after manual review. VOSviewer and CiteSpace softwares were used for bibliometric visualization analysis, including publication trends, geographical distribution characteristics, journal distribution characteristics, author contributions, citations, funding source characteristics, and keyword clustering. Results A total of 2708 papers were analyzed, with an increasing trend in the number of articles and citation frequency from 2015 to 2021. The United States was the most prolific country and France was the most influential country. The University of Pittsburgh in the United States had the highest number of publications among research institutions and showed higher motivation for inter-institutional collaboration. The University of Queensland in the Australia had the highest average citation frequency. Professor Rinaldo Bellomo of Australia was the most productive author and Professor Jeffrey Lipman was the most influential. Jason A. Roberts, Jeffrey Lipman and Claudio Ronco were the three authors who had the highest number of collaborations with other authors. Keyword cluster analysis showed that the prognosis of CRRT for renal disease was the focus of research, with hotspots of research being antibiotics, citrate accumulation, plasma replacement, lactate clearance, acute respiratory distress syndrome, and coronavirus disease 2019. Coupling analysis of the literature showed that exploring the indications for CRRT and optimizing treatment prescription were at the forefront of research. Conclusions The present study of CRRT has generally shown an upward trend in the last decade. The management and efficacy of CRRT remains a hot topic of research. Exploring the indications for CRRT and optimizing treatment prescriptions may be a popular research direction and trend in the future.
Continuous renal replacement therapy (CRRT) is one of the important therapeutic techniques for critically ill patients. In recent years, the field of artificial intelligence has developed rapidly and has been widely applied in manufacturing, automotive, and even daily life. The development and application of artificial intelligence in the medical field are also advancing rapidly, and artificial intelligence radiographic imaging result judgment, pathological result judgment, patient prognosis prediction are gradually being used in clinical practice. The development of artificial intelligence in the field of CRRT has also made rapid progress. Therefore, this article will elaborate on the current application status of artificial intelligence in CRRT, as well as its future prospects in CRRT, so as to provide a reference for understanding the application of artificial intelligence in CRRT.
Objective To analyze the risk factors for death in children with interruption of aortic arch (IAA) and ventricular septal defect (VSD) after one-stage radical surgery. Methods A retrospective analysis was performed on patients with IAA and VSD who underwent one-stage radical treatment in the First Hospital of Hebei Medical University from January 2006 to January 2017. Cox proportional hazards regression model was used to analyze the risk factors for death after the surgery. Results A total of 152 children were enrolled, including 70 males and 82 females. Twenty-two patients died with a mean age of 30.73±9.21 d, and the other 130 patients survived with a mean age of 37.62±11.06 d. The Cox analysis showed that younger age (OR=0.551, 95%CI 0.320-0.984, P=0.004), low body weight (OR=0.632, 95%CI 0.313-0.966, P=0.003), large ratio of VSD diameter/aortic root diameter (VSD/AO, OR=2.547, 95%CI 1.095-7.517, P=0.044), long cardiopulmonary bypass time (OR=1.374, 95%CI 1.000-3.227, P=0.038), left ventricular outflow tract obstruction (LVOTO, OR=3.959, 95%CI 1.123-9.268, P=0.015) were independent risk factors for postoperative death. Conclusion For children with IAA and VSD, younger age, low body weight, large ratio of VSD/AO, long cardiopulmonary bypass time and LVOTO are risk factors for death after one-stage radical surgery.
Hypophosphatemia is a common and potentially serious complication during continuous renal replacement therapy (CRRT), which is often underestimated and ignored. This article systematically searched and reviewed the relevant literature on previous CRRT and hypophosphatemia, and summarized the risk factors affecting hypophosphatemia during CRRT, the impact on the body, and the existing phosphorus supplement scheme during CRRT, so as to attract everyone’s attention to hypophosphatemia during CRRT in clinical work.