RESUMEN
Acute renal failure is common in critically ill patients. Many intensive care unit patients require renal replacement therapy (RRT). Hemodialysis can be performed as intermittent treatments or as continuous RRT, which can be customized to clinical goals by the use of carefully designed replacement fluids and hemodialysates. The available forms of RRT are reviewed, with emphasis on the clinical indications that contribute to the choice and design of therapy. Practical issues and troubleshooting are discussed, as are available options for anticoagulation during RRT. Consideration is given to modality choice, hemodynamic issues, costs, and physiologic outcomes.
Asunto(s)
Lesión Renal Aguda/terapia , Cuidados Críticos/métodos , Diálisis Renal/métodos , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/fisiopatología , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Convección , Enfermedad Crítica/terapia , Soluciones para Diálisis/uso terapéutico , Difusión , Diseño de Equipo , Falla de Equipo , Hemodinámica , Hemorragia/etiología , Humanos , Hipotermia/etiología , Tasa de Depuración Metabólica , Selección de Paciente , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Diálisis Renal/enfermería , Sepsis/complicaciones , Resultado del TratamientoRESUMEN
It is of clinical and financial importance to identify those heart failure patients who are likely to improve rapidly. The authors evaluated, as predictors of short-term resolution, three clinical variables often used to predict long-term outcome. Consenting patients admitted to the emergency department with dyspnea were examined daily until resolution (symptom reversion to baseline absent worsening clinical signs or x-ray). The authors then compared hours to resolution of heart failure with serum B-type natriuretic peptide (BNP), ejection fraction (EF), and admitting physician prediction. They calculated negative and positive predictive values for EF, BNP, and physician opinion using quintile and published severity standards as cutoffs (for EF and BNP). Among 85 patients, BNP <400 pg/mL and <1000 pg/mL had poor positive predictive values (34% and 22%, respectively), as did EF (21%) and physician opinion (16%-21%, depending on physician confidence). Combining tests did not improve prediction. These results do not support the use of BNP, EF, or clinical assessment in triaging heart failure patients to short-stay status.