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Trend of acute dialysis at NTUH SICU in the past 20 year

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Trend of acute dialysis at NTUH SICU in the past 20 year

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    1. Trend of acute dialysis at NTUH SICU in the past 20 year Dr. Wen-Je Ko & NSARF study group SICU, Department of Surgery National Taiwan University Hospital Taipei, Taiwan

    2. 1980+ For ARF at NTUH SICU (national Taiwan University Hospital) (surgical ICU) Usually P/D Occasional IHD because of technical inconvenience CAVH for very critical case (in pre-terminal stage)

    3. 1990+ More IHD (x 4hr) in use: qod ? qd We have our own SICU technicians to do H/D.

    5. In late 1990+ More IHD (x 4hr) in use: qod ? qd We have our own SICU technicians to do H/D. CVVH (the mainstream RRT in SICU) retired Gambro H/D machine no safety device, in fact, a roller pump only Hemofiltration: 999mL/hr upper limit of infusion pump

    8. Self-prepared solution for CVVH: N/S 1000 mL + 4ml MgSO4 (10%) + 20 mL vitaca (2%) half saline 500mL + 40mL NaHCO3 (7%)

    11. CVVH Solution Formula (commercial product by Sintom company)

    14. ECMO + CAVH on the circuit

    18. CVVH 1990+ ~ 2002 at NTUH SICU Main stream for acute dialysis at SICU “Retired” Gambro HF-400 Prisma Prismaflex Fresinius + I-Med PC-4

    23. Problems in CVVH Nurses are unhappy They are not familiar with it. an additional work loading--- clot, alarm, replace fluid, discard waste solution, ……… CVVH, never 24 hours Limited effect (max. HF: 999 x 2 mL/hr in I-Med PC-4 infusion pump)

    25. SICU technician team Jobs: all higher techniques in SICU eg.: ECHO, sona, TCD, ECMO, dialysis, etc ? a professional core team Core team ? some selected member Professional ? enough training

    26. SICU Technician 24/7/365 available

    27. Our present policy for acute dialysis at SICU CVVH: in midnight, emergency indication ? for that night only IE>15 (very unstable hemodynamics) CAVH only for ECMO patients (on the circuit) IHD: IE <3 (stable hemodynamics) SLED: IE 3~15 (unstable hemodynamics) SLED-f (HDF): severe sepsis

    28. SLED vs CVVH at NTUH SICU

    29. SLEDD vs CVVH in NTUH

    30. SLEDD vs CVVH Cost in NTUH

    31. To replace CVVH with SLED?

    35. All in one IHD, EDD SLED, SLED-f (24h) HDF

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