ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
organizations can implement a similar
tool to evaluate their training programs.
The scores can also be used to drive
quality initiatives and track/trend
occurrences.
85. Non-invasive Hemodynamic
Monitoring Used to Determine
Rate of Fluid Removal with
Continuous Renal Replacement
Therapy
Christopher J Burdick, Lauire Grier
Louisiana States University Health
Science Center
Introduction: Hemodynamically
unstable patients in the intensive care
unit (ICU) who develop acute kidney
injury (AKI) have shown to have an
increase in morbidity and mortality.
These patients who develop AKI
frequently require some type of renal
support. Evaluation of volume status in
these patients can be problematic as
typical measures such as decreased urine
output, hypotension, and cardiac
dysfunction are not reliable indices. The
use of non-invasive monitoring in these
situations can assist with the
determination and maintenance of
volume status.
Case: 34 y/o white female presented to
the emergency room with increasing
shortness of breath and dizziness. Pt
states that she has had cough and fever
for 4 days. In emergency room she is
found to be hypotensive and hypoxic.
She was intubated for respiratory
distress and transferred to the ICU for
further care where she was started on
vasopressors and mechanically
ventilated. Over the following three days
the patient developed AKI and was
transferred to our facility for further
management. On arrival to our facility
the patient’s creatinine was found to be
elevated to 2.6 and blood urea nitrogen
(BUN) of 3 and lactic acid of 4.2. She
had been oliguric for past 24hrs and was
6 liters net positive since hospital
admission. Femoral Arterial Catheter
was placed and FloTrac sensor and a
Vigileo monitor (Edwards Lifesciences
Irvine California) attached. Femoral
Venous Dialysis Catheter was placed
and continuous renal replacement
therapy (CRRT) was started. Stroke
Volume Variation (SVV) was monitored
and fluid removal rates were adjusted to
keep SVV between 1-15%. Over the
next 48hrs the vasopressors were
discontinued and the patient’s creatinine
decreased to 1.4, BUN to 2, lactic acid to
1.1 and net fluid balance <strong>from</strong> hospital
admission was decreased to a positive 2
liters. Discussion: Non-invasive
hemodynamic monitoring has been used
to continuously assess fluid status in
hemodynamically unstable ICU patients.
We instituted this technology in this
unstable AKI patient who require CRRT,
and were able to get optimal tissue
perfusion without excessive fluid shifts.
Monitoring SVV enabled us to remove
excessive fluid and minimize episodes of
poor tissue profusion which was
demonstrated by few episodes of
hypotension and improvement of
patients lactic acid.
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