Transcript Prophylactic CRRT - Area

Aspetti clinici della CRRT:
indicazione, timing,
anticoagulazione ed antibiotici
Andrea De Gasperi
2° SAR e Trapianti addominali
Ospedale Niguarda - Ca Granda
Milano
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Criteria for Initiation of RRT
The “RIFLE - SCORE” Approach
RISK
INJURY
Prophylactic
CRRT
Very early
CRRT
Late CRRT
FAILURE
ESRD
LOSS
Diuretics
Recovery
Phase
Mortality (Picard Study)
CRRT - SMART 2008
Criteria for Initiation of RRT
Outcome in Post-Trauma ARF (late vs
early)/Gettings Study
100 Patients – CRRT started after Multiple Trauma
N = 41
BUN < 60 mg/dl
N = 59
BUN > 60 mg/dl
CRRT Initiation
EARLY
LATE
Hospital
Survival
39%
20%
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P < 0,041
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Timing and indications
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Dialysis dose
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Dialysate composition
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Factors able to affect filter life
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the ideal anticoagulant for CRRT
– prevent filter clotting without
inducing haemorrhage
– short half-life
– action limited to the
extracorporeal circuit
• monitoring
– easy
• bedside
– reduced / absent systemic
side effects
– antagonist available
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• Heparin anticoagulation
is the most commonly
used method to prevent
clotting in CRRT
• Often the sole
anticoagulant in
continuous venovenous
hemofiltration
• aPTT or ACT to monitor
heparin effect.
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•CLCRRT of antimicrobial
agents during the
application of CVVH and
CVVHDF
•basis for the optimal
dosage adjustments of
different antimicrobial
agents.
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Protein binding and CRRT
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Protein binding , CRRT
and supplemental dosing
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meropenem
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imipenem
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carbapenemici
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ceftazidime
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ceftriaxone
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Ceftazidime / ceftriaxone
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glicopeptidi
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aminoglicosidi
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chinolonici
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antifungini
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