The International journal of artificial organs
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The Acute Dialysis Quality Initiative (ADQI) is an ongoing process that seeks to produce evidence-based recommendations for the prevention and management of acute kidney injury (AKI) and on different issues concerning acute dialysis. Our methods involve a combination of both expert panel and evidence appraisal, and this approach was chosen to achieve the best of both options. This approach has led to important practice guidelines with wide acceptance and adoption into clinical practice. We further recognize that additional research will be needed and have proposed specific studies that will help move this field forward.
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Clinical Trial
Citrate anticoagulation protocol for slow extended hemodialysis with the Genius dialysis system in acute renal failure.
The Genius dialysis system is increasingly used as an intermittent hemodialysis device in the setting of acute renal failure. Slow extended hemodialysis is preferred in the case of critical ill patients. In this study we established a safe and feasible citrate anticoagulation protocol for slow extended hemodialysis (SLED) with the Genius system. ⋯ Slow extended Genius hemodialysis with citrate is well tolerated and offers a safe and effective alternative to systemic anticoagulation.
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Multicenter Study
The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry.
Well-functioning vascular access is essential for the provision of adequate CRRT. However, few data exist to describe the effect of catheter size or location on CRRT performance in the pediatric population. ⋯ Functional CRRT circuit survival in children is favored by larger catheter diameter, internal jugular vein insertion site and CVVHD. For patients requiring catheter diameters less than 10 French, CRRT circuit survival might be optimized if internal jugular vein insertion is feasible. Conversely, when a vascular access site other than the internal jugular vein is most prudent, consideration should be given to using the largest diameter catheter appropriate for the size of the child. The CVVHD modality was associated with longer circuit survival, but the mechanism by which this occurs is unclear.
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Randomized Controlled Trial
A pilot randomized controlled comparison of extended daily dialysis with filtration and continuous veno-venous hemofiltration: fluid removal and hemodynamics.
Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. ⋯ Adequate prescribed fluid removal was achieved with both techniques. However, as expected, fluid was removed at a faster rate during EDDf. This was initially associated with a lower blood pressure than during CVVH where blood pressure increased.
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The aim of this study was to supplement a previously developed virtual respiratory system (RS) with gas exchange and gas transfer in airways and circulation (GETAC); and to analyze arterial blood oxygenation during apnea when pure O2 is the ambient gas, with and without extracorporeal CO2 removal (ER), for different inspiratory O2 fractions (FiO2) before respiratory halt. ⋯ If ER is available, it is possible to keep both sufficient blood oxygenation and a normal level of CO2 in the blood as well as a relatively low partial pressure of toxic O2 in the lungs without cyclic mechanical action on the diseased lungs or chest.