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Slow continuous therapy

1. Á¾·ù

¨ç slow continuous hemodialysis: CVV-HD, CAV-HD

¨è slow continuous hemofiltration: CVV-H, CVV-H

¨é slow continous ultrafiltration: CVV-U, CAV-U

2. Slow continous hemodialysis(CVV-HD, CAV-HD)

1) rationale

i) hemodynamically well tolerated: minimal change in plasma osmolality

ii) better control of azotemia & electrolyte & acid-base balance

iii) highly effective in removing fluid

iv) parenteral nutritionÅõ¿© ¹× IV medication¿¡ ¿ëÀÌÇÏ´Ù.

2) VV access

subclavian -> subclavian(Áß°£¿¡ hemodialyzer, roller pump)

3) AV access

femoral artery -> femoral vein

* venovenous°¡ arteriovenous accessº¸´Ù ÀåÁ¡

: hematoma¸¦ ÇÇÇÒ¼ö ÀÖ´Ù.

roller pump°¡ ºü¸£´Ù.

±× °á°ú dialyzer performance°¡ Áõ°¡µÇ°í º¸´Ù Áß¿äÇÑ °ÍÀº Ç÷¾×ÀÇ Á¤Ã¼·Î ÀÎÇÑ clottingÀ»

°¨¼Ò½ÃŲ´Ù.

cf. ´ÜÁ¡

Áö¼ÓÀûÀÎ pumpÀÛ¿ëÀ¸·Î ÀÎÇÏ¿© line disconnection or air leakage°¡´É¼ºÀÌ ÀÖ´Ù.

5ÀÏÀÌ»ó catheterÁö¼Ó½Ã exit-site, catheter-induced bacteremia, subclavian vein

thrombosis & stenosisÀ§ÇèÀÌ Áõ°¡ÇÑ´Ù.

4) dialysis solution inflow rateÀÇ °áÁ¤

10 L/dayºÎÅÍ 30 L/dayÀÌ»ó±îÁö °¡´ÉÇÏ´Ù.

residual renal functionÀÌ ¾øÀ» ¶§, hypercatabolic state¿¡¼± ´õ ³ôÀÏ Çʿ䰡 ÀÖ´Ù.

BUN»ý¼º¼Óµµ¸¦ Æò°¡ÇÏ¿© °áÁ¤Çϴµ¥ ICUȯÀÚ´Â º¸Åë 5 - 20 g/dayÀÇ BUNÀÌ »ý»êµÈ´Ù.

(BUN»ý¼º °ø½ÄÀº handbook¿¡ ¿¹Á¦ ³ª¿ÍÀÖÀ½)

5) Àåºñ: pumps

¨ç CVV-HD

48 L/day(2000 ml/hour = 33.3 ml/min)·Î ultrafiltration rate¸¦ settingÇÑ´Ù.

¨è CAV-HD

800 ml/hr(=13.3 ml/min)·Î settingÇÑ´Ù.

3. slow continous hemofiltration(CVV-H, CAV-H)

1) rationale

continous hemodialysis¿Í µ¿ÀÏÇÏ´Ù.

purely convection-based blood cleansing techniqueÀ» ÀÌ¿ëÇÑ´Ù´Â Â÷ÀÌ.

2) solute removal

continous hemofiltrationÀ¸·ÎÀÇ plasma urea clearance´Â continous hemodialysisº¸´Ù

Æò±Õ 50% Àû´Ù.

3) blood access & circuitry

CAV-H´Â CAV-HD¿Í µ¿ÀÏÇϰí CVV-H´Â CVV-HD¿Í µ¿ÀÏÇÏ´Ù.

* CAV-H

femoral artery -> hemofilter -> femoral vein

(heparin) (replacement solution)

4) CAV-HÀÇ GFR: ´ë·« 10L/day = 7 ml/min

4. slow continuous ultrafiltration(CVV-U, CAV-U)