Öz
Akut böbrek hasarı (AKI); yoğun bakım hastalarında prognozu etkileyen yaygın bir komplikasyondur. Yoğun bakımda görülme sıklığı yüksek ve mortalite ile ilişkilidir. Yoğun bakım hastalarının yaklaşık %50’sinde AKI görülür. AKI görülen hastaların, %13,5’i renal replasman tedavisine (RRT) ihtiyaç duyar. Hemodinamik olarak stabil olmayan hastalarda sürekli renal replasman tedavisi (CRRT), sıvı-elektrolit dengesinin düzeltilmesinde yardımcı olmakla kalmaz, aynı zamanda vazopressör kullananlar için de etkili bir tedavi görevi görür.
Günümüzde yaygın olarak kullanılan dört ana RRT türü vardır
1. Standart hemodiyaliz,
2. Periton diyalizi,
3. Yavaş, düşük akımlı günlük diyaliz,
4. CRRT.
AKI olan hastalarda CRRT başlanması, böbrek yetmezliği komplikasyonlarından üremi ve ani ölümü önleyebilir. CRRT’nin zamanlaması, modaliteleri ve doz ayarlamalarının klinik sonuçlar üzerinde etkisine rağmen bu konudaki çalışmalar sınırlıdır. Bu nedenle CRRT’nin AKI yönetimindeki rolü tartışmalı olmaya devam etmektedir.
CRRT’yi başlatırken özel adımlar izlenmelidir. Öncelikle uygun cihaz seçilmeli, hastaya en uygun yöntem belirlenmelidir. Kan akış hızı ve ultrafiltrasyon hızının belirlenmesiyle birlikte filtrasyon için uygun kateter ve filtre seçilmelidir.
Bu derlemede sürekli renal replasman tedavisinin acil endikasyonları, RRT yönteminin tanımı, CRRT programlarının uygulanması, CRRT reçetesi, kan akış hızı ve çözümleri dahil yönetim, komplikasyonlar, antikoagülasyon stratejileri, pıhtılaşma sorunlarının önlenmesi, sitrat birikimi ve kontrendikasyonları tartışılmaktadır.
Sonuç olarak bu konuda yazılan derlemelerin az olması gözönüne alınarak biz de bu konuda eksik olan konu başlıklarını ekleyip pratik uygulamalar ışığında doz hesaplamaları, antikoagülasyon yönetimi gibi konular güncel literatürlerle destekleyerek pratik yaklaşımı sunmayı hedefledik.
Anahtar Kelimeler: Anahtar kelimeler: Akut böbrek hasarı, sürekli renal replasman tedavisi, yoğun bakım
Kaynakça
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