Ammonia Clearance with Different Continuous Renal Replacement Therapy Techniques in Patients with Liver Failure.

Introduction: Continuous renal replacement therapy (CRRT) can be used to treat hyperammonaemia. However, no study has assessed the effect of different CRRT techniques on ammonia clearance.

Methods: We compared 3 different CRRT techniques in adult patients with hyperammonaemia, liver failure, and acute kidney injury.

Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration.

Background: Continuous renal replacement therapy (CRRT) technique may affect circuit lifespan. A shorter circuit life may reduce CRRT efficacy and increase costs.

Methods: In a before-and-after study, we compared circuit median survival time during continuous venovenous hemofiltration (CVVH) versus continuous venovenous hemodialysis (-CVVHD).

Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting.

Continuous renal replacement therapy (CRRT) is intended to function continuously and is prescribed for this outcome. Anticoagulants may not always be used. Clotting and clogging within the CRRT filter stopping therapy occurs with a variability in the total elapsed time associated.

Evaluation of urea and creatinine change during continuous renal replacement therapy: effect of blood flow rate.

Objective: To determine if faster blood flow rate (BFR) has an effect on solute maintenance in continuous renal replacement therapy.

Design: Prospective randomised controlled trial.

Setting: 24-bed, single centre, tertiary level intensive care unit.

Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial.

Objectives: To determine whether blood flow rate influences circuit life in continuous renal replacement therapy.

Design: Prospective randomized controlled trial.

Setting: Single center tertiary level ICU.

Con-Current versus Counter-Current Dialysate Flow during CVVHD. A Comparative Study for Creatinine and Urea Removal.

Background: Dialysate fluid connection to the membrane in continuous dialysis may affect solute clearance. Although circuit connections are routinely made counter-current to blood flow in intermittent dialysis, no study has assessed the effect of this dialysate fluid flow direction on removal of small solutes creatinine and urea during treatment using continuous veno-venous haemodialysis (CVVHD).

Aims: To assess if dialysate flow direction during CVVHD affects small solute removal.

Nasal high-flow oxygen therapy in ICU: A before-and-after study.

Background: Non-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements.

Study Aims: To assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients.

Continuous renal replacement therapy: current practice in Australian and New Zealand intensive care units.

Background: Large multicentre studies of continuous renal replacement therapy (CRRT) in critically ill patients may influence its bedside prescription and practical application. Despite this, many aspects of CRRT may not be informed by evidence but remain a product of clinician preference. Little was known about current CRRT practice in Australia and New Zealand and it is not known if the evidence from recent studies has been integrated into practice.

Early mobilization on continuous renal replacement therapy is safe and may improve filter life.

Introduction: Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population.

A comparison of the Niagara and Medcomp catheters for continuous renal replacement therapy.

Purpose: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction.

Design And Setting: Sequential controlled study in a tertiary, adult intensive care unit (ICU).

Bubble chamber clotting during continuous renal replacement therapy: vertical versus horizontal blood flow entry.

Background: The continuous renal replacement therapy (CRRT) bubble trap chamber is a frequent site of clotting.

Aims: To assess clot formation when comparing our standard 'vertical' blood entry chamber (BEC) with a new 'horizontal' BEC.

Methods: Adult ICU patients requiring CRRT were treated with the vertical BEC and then a similar subsequent cohort with the horizontal BEC in continuous veno-venous haemofiltration mode.

Amino acid balance with extended daily diafiltration in acute kidney injury.

Background: The impact of hybrid dialysis therapies on amino acid (AA) balance in critically ill patients with acute kidney injury is unknown.

Methods: We examined prospectively the AA balance with extended daily diafiltration (EDDF).

Results: We studied 7 patients.

A comparison of the Niagara™ and Dolphin® catheters for continuous renal replacement therapy.

Purpose: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT); specifically, a new surface-modified catheter has been reported to possibly prevent thrombosis and catheter malfunction.

Design And Setting: A sequential, controlled study in a tertiary ICU.

Aims: To compare circuit life when CRRT was performed with a Bard®Niagara™ catheter or the surface-modified GamCath™ Dolphin® Protect 1320 catheter.

Use of an electronic clinical experience portal for the education of nurses in a critical care unit.

This paper examines a clinical experience portal (CEP) that was developed for critical care nurses to access on a personal digital assistant (PDA) while undertaking a 12-month postgraduate program. The increasing complexity of care provided to patients in intensive care units (ICU) in Australia and overseas requires that health care practitioners working in this area are competent and highly skilled, to prevent errors and adverse events. The CEP - unlike the traditional approach which is often lacking, antiquated or encompassed in paper records - provides opportunity for collaborative activities to occur between the learner and the teacher in an auditable environment to enhance the quality of the education provided.

A pilot study of the epidemiology and associations of pulse pressure variation among non-cardiac surgery critically ill patients.

Background: A pulse pressure variation (PPV) ≥ 13% of mean arterial pressure (MAP) is an accepted marker of a fluid-responsive state. However, there is no study of its epidemiology and associations among non-cardiac critically ill patients.

Objectives: To conduct a pilot study of the epidemiology and associations of a PPV ≥ 13% among non-cardiac critically ill patients.

A pilot study of the epidemiology and associations of pulse pressure variation in cardiac surgery patients.

Background: Pulse pressure variation (PPV) is an accepted measure of intravascular filling. It can now be estimated automatically. However, there is limited knowledge of the epidemiology and associations of such estimates in cardiac surgery patients.

Circuit start during continuous renal replacement therapy in vasopressor-dependent patients: the impact of a slow blood flow protocol.

Background And Aims: In vasopressor-dependent patients, we evaluated the impact of a slow blood flow protocol on hypotension when starting continuous renal replacement therapy (CRRT).

Methods: Retrospective observational study in tertiary ICU of a slow blood flow protocol at the start of CRRT circuits.

Results: 205 circuits in 52 patients were studied.

Evaluation of a radial artery cannulation training program for intensive care nurses: a descriptive, explorative study.

Background: Radial arterial line is required for critically ill patients to provide continuous blood pressure monitoring and arterial blood sampling. A program training experienced ICU nurses to perform radial artery cannulation was introduced in a Melbourne metropolitan ICU to allow early treatment and intervention to be delivered to patients while medical staff attend to more urgent diagnostic care. The aim of this research was to evaluate the effectiveness of the training program for radial artery cannulation in the ICU.

Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access.

Introduction: Choice of insertion side and patient position during continuous renal replacement therapy (CRRT) with femoral vein vascular access may affect circuit life. We investigated if there is an association between choice of insertion side and body position and its changes and circuit life during CRRT with femoral vein access.

Methods: We studied 50 patients receiving CRRT via femoral vein access with a sequential retrospective study in a tertiary intensive care unit.

Premature circuit clotting due to likely mechanical failure during continuous renal replacement therapy.

Objective: Failure of extracorporeal circuit (EC) function during continuous renal replacement therapy (CRRT) appears most likely due to progressive circuit clotting or, in some cases, most likely due to mechanical problems that affect flow. We aimed to study the incidence of such likely mechanical circuit failure (MCF).

Design And Setting: Retrospective observational study in an adult ICU of a tertiary hospital.

Clinical nursing for the application of continuous renal replacement therapy in the intensive care unit.

Treatment of critically ill patients with continuous renal replacement therapy (CRRT) requires a set of new skills and knowledge base for the intensive care unit (ICU) nurse. After a decision to treat is made, nurses effectively manage the technique by following a series of steps in sequence. These sequential steps include patient and machine circuit preparation, connection of the extracorporeal circuit (EC) to the patient's vascular access, and nursing management of a treatment in progress.

Nursing for renal replacement therapies in the Intensive Care Unit: historical, educational, and protocol review.

Nurses have made a significant contribution to the development and application of dialysis in the 1950s and continuous renal replacement therapies (CRRT) in the Intensive Care Unit (ICU) setting from the 1980s. Any treatment requires patient and machine-circuit preparation, connection of the extracorporeal circuit (EC) to the patient vascular access catheter and regular tasks to maintain a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine 'vital signs', and then when necessary diagnose circuit clotting and perform a disconnection of the EC from the patient.

Hemodialysis membrane with a high-molecular-weight cutoff and cytokine levels in sepsis complicated by acute renal failure: a phase 1 randomized trial.

Background: Sepsis is the leading cause of acute renal failure. Intermittent hemodialysis (IHD) is a common treatment for patients with acute renal failure. However, standard hemodialysis membranes achieve only little diffusive removal of circulating cytokines.