【持续性肾脏替代治疗CRRT英文】Continuous renal replacement therapy in cardiac surgery.pptVIP

Continuous renal replacement therapy in cardiac surgery Presenter: Ri 謝佳憲 Content Base-line and intra-operative variables Long-term and short term outcomes Timing of CRRT Background ARF necessitating the use of CRRT is a rare but a devastating complication of cardiac surgery Incidence: 2-15% Mortality: 40-80% Etiology Poorly understood Hypo-perfusion of the renal medulla seems to be the most likely mechanism. Nephrotoxic agents, ex. AG, vancomycin Tissue oedema, microembolization.. Base-line and intra-operative variables Baseline variables Definition: serum Cr1 mg/dl above baseline. Associated with the development of ARF following CABG Intra-operative variables Associated with the development of ARF following CABG Conclusion Increased age, black race, carotid bruit, CHF, CVA history, DM, decreased LVEF, increased serum Cr, peripheral arterial disease, increased BW, CPB duration, IABP inserted. Type of surgery v.s Mortality rate Long-term and short-term outcomes Short-term outcome Lango et al.: 30% in-hospital mortality with high volume CRRT. Bent et al.: 40% mortality with early and intensive CRRT. An 80% mortality was reported when CRRT was instituted over a week post-operatively. Long-term outcome Only 2.2% patients require long term CRRT. The long term survival(5 years) was as good as the early survival(1 year). Conclusion Short-term use: improve mortality rate Long-term use: not needed Timing of CRRT Timing of CRRT Two Groups: 1. 27 patients, started when Cr5mg/dl, or K5.5mEq/L. 2. 34 patients, when UOP100ml within consecutive 8 hrs, with no response to 50mg furosemide. Intra- and post op variables Conclusion The sooner the ARF after surgery is recognized and CVVHDF is performed, the higher the likelihood of reduction of the hospital mortality. Renal failure could easily be recognized with Group 2 criteria, thus CRRT could be started ASAP. Reference Acute renal failure following cardiac surgery. Nephrol Dial Transplant(1999)14: