Thank you @ISNkidneycare @ISPD1 for the webinar on #PD in #AKI
Lots of food for thought
Just been looking through my notes -
Lots of food for thought
Just been looking through my notes -
AKI reported in up to a third of ITU patients and just under half of them may require RRT with #COVID19
There is direct evidence of the invasion of SARSCoV-2 into kidney tissue and direct virulence of SARS-CoV-2, factors contributing to acute kidney injury included systemic hypoxia, abnormal coagulation, and possible drug or hyperventilation-relevant rhabdomyolysis
https://www.kidney-international.org/article/S0085-2538(20)30369-0/fulltext
Abnormal">https://www.kidney-international.org/article/S... clotting leads to early filter clotting and line problems with CRRT and HD
Abnormal">https://www.kidney-international.org/article/S... clotting leads to early filter clotting and line problems with CRRT and HD
2 types of lung involvement in COVID19 pneumonia
Type 1 Near normal pulmonary compliance with isolated viral pneumonia
type 2 -Decreased pulmonary compliance
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02880-z
Prone">https://ccforum.biomedcentral.com/articles/... ventilation sometimes helpful
Fluid balance not easy – even in the ICU
Type 1 Near normal pulmonary compliance with isolated viral pneumonia
type 2 -Decreased pulmonary compliance
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02880-z
Prone">https://ccforum.biomedcentral.com/articles/... ventilation sometimes helpful
Fluid balance not easy – even in the ICU
Does filtration help with the cytokine storm? NO
https://journals.lww.com/ccmjournal/Abstract/2002/01000/A_phase_II_randomized,_controlled_trial_of.16.aspx
https://journals.lww.com/ccmjourna... href=" https://journals.lww.com/ccmjournal/Abstract/2009/03000/Impact_of_continuous_venovenous_hemofiltration_on.1.aspx">https://journals.lww.com/ccmjourna...
https://journals.lww.com/ccmjournal/Abstract/2002/01000/A_phase_II_randomized,_controlled_trial_of.16.aspx
https://journals.lww.com/ccmjourna... href=" https://journals.lww.com/ccmjournal/Abstract/2009/03000/Impact_of_continuous_venovenous_hemofiltration_on.1.aspx">https://journals.lww.com/ccmjourna...
What are the advantages of acute PD in the ITU for covid19 patients? But there are disadvantages too ..
And what about the raised Intra-abdominal pressure that PD generates?- does it affect respiratory capacity – no- not usually
https://www.tandfonline.com/doi/full/10.3109/0886022X.2013.876353
https://www.tandfonline.com/doi/full/... href=" https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)32873-8">https://linkinghub.elsevier.com/retrieve/...
https://www.tandfonline.com/doi/full/10.3109/0886022X.2013.876353
https://www.tandfonline.com/doi/full/... href=" https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)32873-8">https://linkinghub.elsevier.com/retrieve/...
ISPD guidelines for mx of AKI with PD http://www.pdiconnect.com/content/34/5/494.full.pdf+html">https://www.pdiconnect.com/content/3...
What is the evidence for acute PD in AKI?
https://doi.org/10.1002/14651858.CD011457.pub2
Good">https://doi.org/10.1002/1... evidence from #savingyounglives programme from @ISN that acute PD does save lives
As well as studies from the critical care environment
https://doi.org/10.1002/14651858.CD011457.pub2
Good">https://doi.org/10.1002/1... evidence from #savingyounglives programme from @ISN that acute PD does save lives
As well as studies from the critical care environment
And why PD ?
The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.
https://www.ncbi.nlm.nih.gov/pubmed/32105632 ">https://www.ncbi.nlm.nih.gov/pubmed/32...
The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.
https://www.ncbi.nlm.nih.gov/pubmed/32105632 ">https://www.ncbi.nlm.nih.gov/pubmed/32...
Acute PD studies in critical care show it works
Flow chart for how to PD in AKI
Conclusion from Dr Cullis
Flow chart for how to PD in AKI
Conclusion from Dr Cullis
Now nearer to home - London has had the bull of #COVID19 patients and their experience is fascinating
Thanks to all the speakers and the @ISNkidneycare and @ISPD1 for a hugely informative hour which I am sure will inform our management of AKI in #COVID19 in the ITU