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: Clinical review: Patency of the circuit in continuous renal replacement therapy. | Available online http content 11 4 218 Review Clinical review Patency of the circuit in continuous renal replacement therapy Michael Joannidis1 and Heleen M Oudemans-van Straaten2 1Medical Intensive Care Unit Division of General Internal Medicine Department of Internal Medicine Medical University Innsbruck Anichstr. 35 6020 Innsbruck Austria 2Department of Intensive Care Medicine Onze Lieve Vrouwe Gasthuis Oosterpark 9 1091 AC Amsterdam The Netherlands Corresponding author Heleen M Oudemans-van Straaten Published 12 July 2007 Critical Care 2007 11 218 doi cc5937 This article is online at http content 11 4 218 2007 BioMed Central Ltd Abstract Premature circuit clotting is a major problem in daily practice of continuous renal replacement therapy CRRT increasing blood loss workload and costs. Early clotting is related to bioincompatibility critical illness vascular access CRRT circuit and modality. This review discusses non-anticoagulant and anticoagulant measures to prevent circuit failure. These measures include optimization of the catheter inner diameter pattern of flow and position the settings of CRRT partial predilution and individualized control of filtration fraction and the training of nurses. In addition anticoagulation is generally required. Systemic anticoagulation interferes with plasmatic coagulation platelet activation or both and should be kept at a low dose to mitigate bleeding complications. Regional anticoagulation with citrate emerges as the most promising method. Introduction During continuous renal replacement therapy CRRT blood is conducted through an extracorporeal circuit activating coagulation by a complex interplay of patient and circuit. Critically ill patients may develop a procoagulant state due to early sepsis hyperviscosity syndromes or antiphospholipid antibodies. In early sepsis activation of the coagulation system is triggered by proinflammatory cytokines that enhance .
