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

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G15 Fluids and Solutions in the Critically Ill 2: Solutions for CRRT Educational Objectives: 1. Describe the composition of solutions for CRRT 2. Describe the spectrum of solute not replaced during CRRT 3. Describe the complications associated with solution for CRRT Sean Bagshaw MD, MSc, FRCPC 8:15-9:45 Wednesday, February 15 Content Description: Solutions for CRRT can be either custom (i.e. compounded in local pharmacy) or commercially prepared. Commercially prepared solutions are generally safer; however, may be more expensive. There is no practice differences in the composition of fluids for either replacement and dialysate solutions, except in specific circumstances (i.e. use of regional citrate anticoagulation [RCA]). In general, CRRT solutions are isotonic and balanced. The sodium [Na] concentration found in CRRT solutions is generally maintained within the normal physiologic range, often with varying quantities of additional electrolytes added (i.e. potassium, magnesium, chloride). The [Na] concentration may need to be adjusted; however, when using RCA or if critically ill patients receiving CRRT have severe disorders of [Na] balance (i.e. hyponatremia/hypernatremia). Current evidence preferentially supports the use of bicarbonate [HCO3] as base buffer over lactate or acetate-based solutions. Several additional electrolytes (i.e. phosphate, glucose), amino acids (i.e. glutamine), trace elements (i.e. thiamine) can be readily depleted during CRRT and may require supplementation. Suggested Reading: 1. Tan HK, Uchino S, Bellomo R. The acid-base effects of continuous hemofiltration with lactate or bicarbonate buffered replacement fluids. Int J Artif Organs. Jun 2003;26(6):477-483. 2. Barenbrock M, Hausberg M, Matzkies F, de la Motte S, Schaefer RM. Effects of bicarbonate- and lactatebuffered replacement fluids on cardiovascular outcome in CVVH patients. Kidney Int. Oct 2000;58(4):1751- 1757. 3. Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol. Jan 2006;1(1):79-87. 4. Oudemans-van Straaten HM, Bosman RJ, Koopmans M, et al. Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med. Feb 2009;37(2):545-552. 5. Demirjian S, Teo BW, Guzman JA, et al. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant. Nov 2011;26(11):3508-3514. 6. Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand. Jan 2011;55(1):39-45. 7. Ostermann M, Dickie H, Tovey L, Treacher D. Management of sodium disorders during continuous haemofiltration. Crit Care. 2010;14(3):418. 8. Celik JB, Topal A, Kartal E, Yosunkaya A. Clinical outcome following the use of inadequate solutions for continuous veno-venous hemodiofiltration. Ren Fail. 2008;30(10):959-964. 91
H16 Preventing and Managing Complications of Dialysis 2: Operation, Fluids, Electrolytes and Acid Base Maureen Craig MSN, RN, CNN 8:15-9:45 Wednesday, February 15 Educational Objectives: 1. Review learning points <strong>from</strong> experienced CRRT/SLEDD programs, including adaptations for pediatric and infant patients, citrate toxicity, calculating UFR's and meaningfully documenting fluid balance, adding phosphorus to dialysis solutions, and antibiotic managment on CRRT. Content Description: Experienced acute dialysis programs continue to face challenges in delivering CRRT/SLEDD and IHD. Underdosing antibiotics with todays more efficient filters can lead to therapeutic failure and breakthrough resistance. Connecting with pharmocotherapy resources can help you adjust antibiotics with confidence. Umbilical catheters can be used for infant CRRT with flows of 10-50 ml/min. The infant CRRT circuit may best be anticoagulated with regional citrate anticoagulation. Citrate toxicity can occur, but can be modified by increases in dialysis flow rates. When a patient's size requires a blood-primed circuit, packed red blood cells can be combined with saline to prime the circuit effectively. Adjusting the ultrafiltration rate in a contstantly changing ICU patient environment can be challenging if documentation is not simplified so that adjustments can be made at any time of the hour. Documentation can be simplified so the ICU nurse is always maintaining the ideal ultrafiltration rate; balancing the fluid goals for the patient with the patient's response to treatment. Serum phosphorus values can fall during CRRT/SLEDD treatments. Adding phosphorus to dialysis solutions can protect the patient against hypophosphatemia. Suggested Reading: Craig, M. (2008). Slow extended daily dialysis and continuous renal replacement therapy. In C. Counts (Ed.), Core Curriculum for Nephrology Nursing (5th ed.), (pp.231-278). Pitman, NJ: American Nephrology Nursing Association. Brett H. Heintz, Gary R. Matzke, William E. Dager Pharmacotherapy. 2009 May; 29(5): 562–577. doi: 10.1592/phco.29.5.562 Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. 92
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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SPECIAL LECTURE Engineering Critica
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Nishimura R, Ornato JP, Page RL, Ri
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Do Vasoactive Drugs and Fluids Impr
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Blood Transfusions are Important fo
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Thinking Outside of the Box: A Nove
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Page 48 and 49: Myocardial Stunning and Brain Edema
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Page 58 and 59: Improving Outcomes from</st
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Page 70 and 71: A01 Assessing the Microcirculation
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