Aspetti clinici della CRRT indicazione timing anticoagulazione ed
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Aspetti clinici della CRRT: indicazione, timing, anticoagulazione ed antibiotici Andrea De Gasperi 2° SAR e Trapianti addominali Ospedale Niguarda - Ca Granda Milano CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008
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Criteria for Initiation of RRT The “RIFLE - SCORE” Approach RISK INJURY Prophylactic CRRT Very early CRRT Late CRRT FAILURE ESRD LOSS Diuretics Recovery Phase Mortality (Picard Study) CRRT - SMART 2008
Criteria for Initiation of RRT Outcome in Post-Trauma ARF (late vs early)/Gettings Study 100 Patients – CRRT started after Multiple Trauma N = 41 BUN < 60 mg/dl N = 59 BUN > 60 mg/dl CRRT Initiation EARLY LATE Hospital Survival 39% 20% CRRT - SMART 2008 P < 0, 041
CRRT - SMART 2008
CRRT - SMART 2008
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Timing and indications CRRT - SMART 2008
Dialysis dose CRRT - SMART 2008
Dialysate composition CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008
Factors able to affect filter life CRRT - SMART 2008
CRRT - SMART 2008
the ideal anticoagulant for CRRT – prevent filter clotting without inducing haemorrhage – short half-life – action limited to the extracorporeal circuit • monitoring – easy • bedside – reduced / absent systemic side effects – antagonist available CRRT - SMART 2008
CRRT - SMART 2008
• Heparin anticoagulation is the most commonly used method to prevent clotting in CRRT • Often the sole anticoagulant in continuous venous hemofiltration • a. PTT or ACT to monitor heparin effect. CRRT - SMART 2008
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• CLCRRT of antimicrobial agents during the application of CVVH and CVVHDF • basis for the optimal dosage adjustments of different antimicrobial agents. CRRT - SMART 2008
CRRT - SMART 2008
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CRRT - SMART 2008
Protein binding and CRRT - SMART 2008
Protein binding , CRRT and supplemental dosing CRRT - SMART 2008
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meropenem CRRT - SMART 2008
imipenem CRRT - SMART 2008
carbapenemici CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008
ceftazidime CRRT - SMART 2008
ceftriaxone CRRT - SMART 2008
Ceftazidime / ceftriaxone CRRT - SMART 2008
CRRT - SMART 2008
glicopeptidi CRRT - SMART 2008
aminoglicosidi CRRT - SMART 2008
CRRT - SMART 2008
chinolonici CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008
antifungini CRRT - SMART 2008
CRRT - SMART 2008
CRRT - SMART 2008