Kidney international. Supplement
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Temporary vascular access is an essential component to perform any extracorporeal renal replacement therapy (RRT) in the acute renal failure patient. RRT used in the acute setting may be categorized in two groups: intermittent (IRRT) and continuous (CRRT). Therapeutic indications are based on clinical and technical considerations. ⋯ Late and/or delayed dysfunctioning of catheters are indicative of a thrombosis. Performance standards of catheters are less of a limiting factor in continuous low flow RRT modalities than in the intermittent ones. Finally, careful handling of the catheter essential to prevent infectious complications.
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We describe our experience with continuous renal replacement therapy (CRRT) in critically ill neonates. From June 1995 to June 1997 36 critically ill oliguric or anuric infants and children underwent continuous arterio-venous (N = 17) or veno-venous (N = 15) renal support. In addition, four neonates were treated with continuous ultrafiltration (CUF) during extracorporeal membrane oxygenation (ECMO) because of severe diuretic-resistant hypervolemia. ⋯ CRRT related complications included local bleeding at the catheter entrance site, partial thrombosis of the inferior or superior caval veins and transient ischemia due to femoral artery catheters. Continuous hemofiltration either driven in the arterio-venous or veno-venous mode is a very effective method of renal support for critically ill neonates to control fluid balance and metabolic derangement. Urea clearance can be improved by adding some dialysate fluid in a countercurrent direction to blood flow.
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Several factors combine to facilitate the evolution towards heart and multi-organ failure following cardiac surgery. Some of these factors are related to pure cardiac aspects, for example, the existence of a preoperative heart disease, the use of aortic cross clamping or performance of cardiotomy. Cardiopulmonary bypass (CPB) also plays an important role in the occurrence of postoperative organ dysfunctions by two principal means. ⋯ Initially hemofiltration was intended to correct the accumulation of extravascular water during or immediately following the surgical procedure. Nevertheless, several of its side-effects appeared to be useful, such as the reduction of postoperative blood loss and immediate improvement in hemodynamics. Several studies attempted to point out the mechanism of action of hemofiltration and although removal of inflammatory mediator occurs, there is currently no proof that this removal is the actual mechanism by which this technique acts.
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Review Comparative Study
Continuous versus intermittent renal replacement therapy in the intensive care unit.