【持续性肾脏替代治疗CRRT英文精品课件】Continuousrenalreplacementtherapyincardiacsurgery.pptxVIP

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【持续性肾脏替代治疗CRRT英文精品课件】Continuousrenalreplacementtherapyincardiacsurgery.pptx

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r ?宀Continuous renal replacement therapy in cardiac surgeryPresenter: Ri 謝佳憲Content■ Base-line and intra-operative variables■ Long-term and short term outcomes■ Timing of CRRTBackground■ 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 variablesBaseline variables■ Definition: serum Cr1 mg/dl above baseline.■ Associated with the development of ARF following CABGBaseline variablesORAge1.1Sex%(male/female )0.86Race(whiteZblack)1.5Carotid bruit1.8CHF2.1Previous CVA1.9Diabetes2Ejaction fraction1.1Peripheral artery disease1.2Weight1.2COPD0.96Serum creatinine1.4Intra-operative variables■ Associated with the development of ARF following CABGintra-operative variablesORBypass time1.07No. of grafts1IABP inserted3.2Inflow temperature0.9Nasal temperature0.9Conclusion■ 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 rateType of surgeryMortality(%)CABG33.3CABG+ valve surgery57.1Valve surgery60Redo-CABG or redo-valve surgery86Long-term and short-term outcomesShort-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).LoqoumraAMS80100Conclusion■ Short-term use: improve mortality rate■ Long-term use: not neededTiming of CRRTTiming of CRRT■ Two Groups:1.27 patients, started when Cr5mg/dl, or K5.5mEq/L.2. 34 patients, when UOP100ml within consecutive 8 hrs,