期刊
JOURNAL OF CRITICAL CARE
卷 72, 期 -, 页码 -出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2022.154169
关键词
Mechanical fluid removal; Perfusion; Deresuscitation; Continuous renal replacement therapy; Fluid balance
This study implemented a perfusion-based deresuscitation protocol to guide fluid removal during continuous renal replacement therapy (CRRT) and found that this strategy achieved a greater negative cumulative fluid balance compared to standard practices, with good hemodynamic tolerance.
Background: Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. We have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the fluid balance.Methods: Consecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, net ultrafiltration (UFnet) of 2 mL/kg/h, and monitoring of perfusion (early dry group, N = 42) and were compared to a historical group managed according to usual practices (control group, N = 45). The primary outcome was the cumulative fluid balance at day 5 or at discharge.Results: Adjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: -7784 [-11,833 to -2933] mL) compared to the control group (-3492 [-9935 to -1736] mL; p = 0.04). The differ-ence was mainly driven by a greater daily UFnet (31 [22-46] mL/kg/day vs. 24 [15-32] mL/kg/day; p = 0.01). There was no significant difference between both groups regarding hemodynamic tolerance.Conclusion: Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated.(c) 2022 Elsevier Inc. All rights reserved.
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