tailieunhanh - Báo cáo y học: "A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients. | Available online http content 13 6 317 Viewpoint A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients Sean M Bagshaw1 Dinna N Cruz2 RT Noel Gibney1 and Claudio Ronco2 1 Division of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta T6G 2B7 Canada 2Department of Nephrology Dialysis and Transplantation and International Renal Research Institute Vicenza IRRIV San Bortolo Hospital 36100 Vicenza Italy Contributed equally Corresponding author Dinna N Cruz dinnacruzmd@ Published 11 November 2009 Critical Care 2009 13 317 doi cc8037 This article is online at http content 13 6 317 2009 BioMed Central Ltd Abstract Critically ill patients whose course is complicated by acute kidney injury often receive renal replacement therapy RRT . For these patients initiation of RRT results in a considerable escalation in both the complexity and associated cost of care. While RRT is extensively used in clinical practice there remains uncertainty about the ideal circumstances of when to initiate RRT and for what indications. The process of deciding when to initiate RRT in critically ill patients is complex and is influenced by numerous factors including patient-specific and clinician-specific factors and those related to local organizational logistical issues. Studies have shown marked variation between clinicians and across institutions and countries. As a consequence analysis of ideal circumstances under which to initiate RRT is challenging. Recognizing this limitation we review the available data and propose a clinical algorithm to aid in the decision for RRT initiation in critically ill adult patients. The algorithm incorporates several patient-specific factors based on evidence when available that may decisively influence when to initiate RRT. The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in .