1. When should renal replacement therapy (RRT) be initiated? There are accepted urgent indications for RRT in patients with acute kidney injury (AKI) and generally include: refractory fluid overload, hyperkalemia >6 mEq/L or rapidly rising potassium levels, signs of uremia,…
Pathophysiology The main causes of acute kidney injury (AKI) are associated with decreased kidney perfusion. A decrease in oxygen delivery severe or prolonged enough to impair cellular function can cause tubular or vascular endothelial dysfunction. The mismatch between oxygen delivery…
Objectives This chapter will: 1. Explain and describe the main clinical indications for starting continuous renal replacement therapy (CRRT). 2. Consider renal and nonrenal indications of CRRT. 3. Provide theoretical support for the early application of CRRT to control fluid…
Objectives This chapter will: 1. Evaluate the factors that determine need for dialytic intervention in critically ill patients and describe the current status of initiation of renal replacement therapy in the intensive care unit (ICU). 2. Define and contrast approaches…
Anticoagulation Intermittent Hemodialysis Heparin Clotting Membrane There is a fine balance between hemostasis and hemorrhage in the human body, managed by a complex system of plasma, cellular, and endothelial factors. Coagulation is the normal process occurring when vascular injury results…
Objectives This chapter will: 1. Review the pathophysiology related to fluid status and the four phases of fluid resuscitation. 2. Review clinical parameters available to assess fluid volume, fluid responsiveness, and fluid overload. 3. Discuss practical issues regarding fluid administration…