Discover and read the best of Twitter Threads about #CRRT
Most recents (7)
Another week, another pod open and a new one on the making. The workload is growing and getting heavier. Things don’t always fall to place as planned. BUT there are loads of good people bringing help where it wasn’t expected. SO many thanks to
@SurgeryRlh managers and beyond for kitting out 15C,15E, 15F,14C and 14D = 150 ITU beds. It’s slick but hard work 😓 scrubs definitely suit you
@gareth_grier @alice_kershberg Frank et al @ #familycommshub for taking care of families and loved ones while #nurses are stretched doing the physical caring. This is where kindness meets meticulous processes to ensure no one is left out
Watching Dr Trung Nguyen discussing the indications and outcomes of therapeutic plasma exchange in #PedsICU #WFPICCS20
A thread to follow....
A thread to follow....
Within plasma there can be molecules that are harmful/toxic that you may want to remove, without removing the rest of the blood molecules...
Three options exist to purify blood 👇
#PedsICU #WFPICCS20
Three options exist to purify blood 👇
#PedsICU #WFPICCS20
First is haemofiltration: the limit here is the size of the molecules you want to remove vs the size of the filter membrane...
But it is a technique many #PICU are familiar with for #CRRT
#PedsICU #WFPICCS20
But it is a technique many #PICU are familiar with for #CRRT
#PedsICU #WFPICCS20
To this day: NO difference in outcomes between
- #CRRT vs HD/ PIRRT
- Difussion vs Convection
- Std vs ⬆️ dose
- Early vs Late ⏰
The problem is #AKI & what it represents. #KRT can’t change that, no matter how you do it
💥SOLUTE & VOLUME control💥
becomes the only GOAL
- #CRRT vs HD/ PIRRT
- Difussion vs Convection
- Std vs ⬆️ dose
- Early vs Late ⏰
The problem is #AKI & what it represents. #KRT can’t change that, no matter how you do it
💥SOLUTE & VOLUME control💥
becomes the only GOAL
What?
1. Nutrition 🥩
2. Potassium 🍌
3. Acid base 🧪
4. Phosphorus 🦴
5. Fluid balance 💧
1. Nutrition 🥩
2. Potassium 🍌
3. Acid base 🧪
4. Phosphorus 🦴
5. Fluid balance 💧
Today I woke up and realized I had homework assigned by @ArgaizR
He asked me to complement his thread about the recent NEJM case, regarding the CRRT approach. Why me? 🤷🏻♂️ who knows
but I always turn in my homework, so here it is ——-thread 🧵 #CRRT #COVID19 #AKI
He asked me to complement his thread about the recent NEJM case, regarding the CRRT approach. Why me? 🤷🏻♂️ who knows
but I always turn in my homework, so here it is ——-thread 🧵 #CRRT #COVID19 #AKI
So the case is very representative of what we are all seeing in #COVID19 patients:
1️⃣A lot of AKI
2️⃣Intrinsic etiology (host or direct)
3️⃣Many need KRT (RRT)
4️⃣KRT resources are not enough
5️⃣A lot of circuit clotting
6️⃣Nephrologists with headaches
👇
1️⃣A lot of AKI
2️⃣Intrinsic etiology (host or direct)
3️⃣Many need KRT (RRT)
4️⃣KRT resources are not enough
5️⃣A lot of circuit clotting
6️⃣Nephrologists with headaches
👇
The problem:
Many patients need KRT at the same time, fancy CRRT prescriptions (low efficiency, continuous, kidney like) are not practical, enough or feasible do to clotting
Just like a normal non pandemic day in Mexico 🇲🇽
Many patients need KRT at the same time, fancy CRRT prescriptions (low efficiency, continuous, kidney like) are not practical, enough or feasible do to clotting
Just like a normal non pandemic day in Mexico 🇲🇽
I've been asked about home-made #CRRT solutions for the pandemic. For safety reasons, I believe in using pre-made solutions with limited customization whenever possible. However, I realize that some institutions are running out of solutions. I offer the following Tweetorial:
CJASN just published a nice review for how to address resource allocation for dialysis and CRRT: tinyurl.com/rklnuen
In this paper they provide a 4 solution recipe to make a Calcium-containing CRRT solution. The solution can be made by pharmacy using TPN Compounders.
In this paper they provide a 4 solution recipe to make a Calcium-containing CRRT solution. The solution can be made by pharmacy using TPN Compounders.
That CJASN solution contains calcium, therefore it shouldn't be used where citrate anticoagulation is used for CRRT. In the early days of CRRT, we made a no-calcium CRRT solution from 2 base solutions that were infused simultaneously at equal rates. tinyurl.com/vghskxe
1/20 SLED
#CRRT and #IHD are different treatments, we know now
But, Is there something in between?
✅YES & it´s called...
🤔Wait, whats the name?
#SLED? #PIRRT? #HYBRID? #SHIFT? #AVVH?
💥Lets review this confusing & amazing topic
#tweetorial
#CRRT and #IHD are different treatments, we know now
But, Is there something in between?
✅YES & it´s called...
🤔Wait, whats the name?
#SLED? #PIRRT? #HYBRID? #SHIFT? #AVVH?
💥Lets review this confusing & amazing topic
#tweetorial
2/20
When giving RRT to critical ill patients with AKI #CRRT & #iHD have different advantages
#CRRT
✅Hemodynamic stability
✅Gentle solute removal
✅Steady state similar to kidney
#iHD
✅Lower Cost
✅Machine free time
✅Equipment almost always available
When giving RRT to critical ill patients with AKI #CRRT & #iHD have different advantages
#CRRT
✅Hemodynamic stability
✅Gentle solute removal
✅Steady state similar to kidney
#iHD
✅Lower Cost
✅Machine free time
✅Equipment almost always available
3/20
Therapies mixing the best of both worlds, have being present for a while
💥Smart people delivering what´s NEEDED with the tools AVAILABLE
💥What´s NEEDED?: Replace renal function on unstable critically ill patients without actually killing the patient in the process
Therapies mixing the best of both worlds, have being present for a while
💥Smart people delivering what´s NEEDED with the tools AVAILABLE
💥What´s NEEDED?: Replace renal function on unstable critically ill patients without actually killing the patient in the process
📈CRRT 📉
📝Prescription 📝
&
🔮Prediction of Delivered Dose🔮
Using the ADEQUATOR
#CRRT #nephrology #AKI #criticalnephrology @RenalFellowNtwk @adequator_app
📝Prescription 📝
&
🔮Prediction of Delivered Dose🔮
Using the ADEQUATOR
#CRRT #nephrology #AKI #criticalnephrology @RenalFellowNtwk @adequator_app
2/8👨🏽💼Male 50 years old needs CRRT for volume control and AKI
- 100 kg, 170 cm height, Htct 35%
- Modality CVVHDF
- Prescribed dose 25 ml/kg/hr
- Anticoagulation: none
- Institution down time average: 2 hours
- Urea cl dose based, so we use SC of 1
- 100 kg, 170 cm height, Htct 35%
- Modality CVVHDF
- Prescribed dose 25 ml/kg/hr
- Anticoagulation: none
- Institution down time average: 2 hours
- Urea cl dose based, so we use SC of 1
3/8The calculator will give you the amount of volume “dose” to distribute:
25x100kg——>2500 ml/hr
Distribute the volume at your preference
Dialysate —————1100 ml/hr
Replacement PRE —1100 ml/hr
Replecement POST -200ml/hr
Fluid Removal ———100 ml/hr
25x100kg——>2500 ml/hr
Distribute the volume at your preference
Dialysate —————1100 ml/hr
Replacement PRE —1100 ml/hr
Replecement POST -200ml/hr
Fluid Removal ———100 ml/hr
