dialysis in the ICU

Up to 70% of patients require renal replacement therapy or dialysis. Dialysis is renal therapy via diffusion of small solutes, whereas filtration is the convection of large solutes. Early treatment is better, obviously…

  1. intermittent hemodialysis: is easier to implement, more practical, better solute clearance and fewer bleeding complications
  2. continuous dialysis: better for hemodynamically unstable patients, if have renal and hepatic failure, or acute brain injury
    1. requires continuous anticoagulation with heparin or UFH
    2. citrate may cause electrolyte issues (chelates ionized Ca)
    3. CVVHDF=continuous venovenous hemodiafiltration=dialysis +filtration. The #1 modality in the ICU. Large volume, requires fluid replacement.
    4. CAVHD or AVHDF requires arterial cannulation, and is unreliable in pts with low BP, PVD. More risky.
  3. peritoneal dialysis
  4. SLEDD (hybrid of intermittent and continuous): more flexible than continuous, less need for anticoagulation, but has the same efficacy as continuous
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s