【持续性肾脏替代治疗crrt英文精品课件】continuous renal replacement therapy in cardiac surgery

Continuousrenalreplacementtherapyincardiacsurgery Presenter Ri謝佳憲 Content Base lineandintra operativevariablesLong termandshorttermoutcomesTimingofCRRT Background ARFnecessitatingtheuseofCRRTisararebutadevastatingcomplicationofcardiacsurgeryIncidence 2 15 Mortality 40 80 Etiology PoorlyunderstoodHypo perfusionoftherenalmedullaseemstobethemostlikelymechanism Nephrotoxicagents ex AG vancomycinTissueoedema microembolization Base lineandintra operativevariables Baselinevariables Definition serumCr 1mg dlabovebaseline AssociatedwiththedevelopmentofARFfollowingCABG Intra operativevariables AssociatedwiththedevelopmentofARFfollowingCABG Conclusion Increasedage blackrace carotidbruit CHF CVAhistory DM decreasedLVEF increasedserumCr peripheralarterialdisease increasedBW CPBduration IABPinserted Typeofsurgeryv sMortalityrate Long termandshort termoutcomes Short termoutcome Langoetal 30 in hospitalmortalitywithhighvolumeCRRT Bentetal 40 mortalitywithearlyandintensiveCRRT An80 mortalitywasreportedwhenCRRTwasinstitutedoveraweekpost operatively Long termoutcome Only2 2 patientsrequirelongtermCRRT Thelongtermsurvival 5years wasasgoodastheearlysurvival 1year Conclusion Short termuse improvemortalityrateLong termuse notneeded TimingofCRRT TimingofCRRT TwoGroups 1 27patients startedwhenCr 5mg dl orK 5 5mEq L 2 34patients whenUOP 100mlwithinconsecutive8hrs withnoresponseto50mgfurosemide Intra andpostopvariables Conclusion ThesoonertheARFaftersurgeryisrecognizedandCVVHDFisperformed thehigherthelikelihoodofreductionofthehospitalmortality RenalfailurecouldeasilyberecognizedwithGroup2criteria thusCRRTcouldbestartedASAP Reference Acuterenalfailurefollowingcardiacsurgery NephrolDialTransplant 1999 14 1158 62Longandshort termoutcomesinpatientsrequiringcontinuousrenalreplacementtherapypostcardiopulmonarybypass EuropeanJournalofCardio thoracicsurgery27 2005 906 909TimingofReplacementTherapyforAcuteRenalFailureAfterCardiacSurgery JCardSurg2004 19 17 20Continuo