關(guān)鍵字：2009,英國(guó),ICU,腎臟替代治療,指南,英文,透析,管理,抗凝,透析器,兒童

---

簡(jiǎn)介：The purpose of this document is to summarise current options and best evidence available for provision of renal replacement therapy (RRT) in critically ill patients and to outline guidance on how these can be implemented in the safest and most effective manner. The document primarily describes standards for RRT in critically ill patients with acute kidney injury (AKI) and concomitant other organ (system) injury receiving Level 2 or Level 3 critical care. In certain circumstances, such as during the recovery phase from critical illness, these standards may be appropriate for patients receiving Level 1 care in a critical care setting. These standards are not intended for the patients with AKI or chronic renal insufficiency receiving Level 1 care in other clinical areas (e.g. nephrology wards).

The purpose of this document is to summarise current options and best evidence available for provision of renal replacement therapy (RRT) in critically ill patients and to outline guidance on how these can be implemented in the safest and most effective manner. The document primarily describes standards for RRT in critically ill patients with acute kidney injury (AKI) and concomitant other organ (system) injury receiving Level 2 or Level 3 critical care. In certain circumstances, such as during the recovery phase from critical illness, these standards may be appropriate for patients receiving Level 1 care in a critical care setting. These standards are not intended for the patients with AKI or chronic renal insufficiency receiving Level 1 care in other clinical areas (e.g. nephrology wards).
Crucial to the care of the critically ill patients with impending AKI is the concept that in the early phase of a serious illness, renal impairment may be avoidable or reversible and hence concentrated efforts should be made to prevent the need for RRT. The extent to
which such efforts should be pursued may be influenced by the stability of the patient’s condition, the presence of pre-existing renal impairment and the duration of the period for which renal compromise has been present.
In general, intermittent haemodialysis (IHD) is still the most frequently used method of renal support for majority of the patients with AKI, but for the critically ill patients with AKI continuous forms of renal replacement therapy are often used in the UK intensive care
units (ICUs). Although both continuous renal replacement therapy (CRRT) and IHD may employ similar principles of clearance of uraemic toxins, there are important differences in the actual mode of solute removal and delivery of therapy.
In order to deliver optimum care with minimal treatment interruptions, health care workers (HCWs) on the ICU should have an understanding of the principles of CRRT. This includes the relevance of extracorporeal blood flow rates, ultrafiltrate production, anticoagulation and drug dosing principles. Good vascular access is important and it is essential that care of the access device is meticulous so as to preserve flows and reduce the risk of infection. HCWs should be familiar with the equipment available in their units and understand the operational characteristics. They should also be aware of all potential adverse effects of this invasive procedure in their patients. There are no nationally agreed standards for competencies in delivering CRRT in the critically ill.
Although this document suggests a list of competencies, each unit is encouraged to develop competencies locally.