Abstract：
BACKGROUND: Continuous haemoglobin, venous blood oxygen saturation, and haematocrit (Hct) monitoring is currently not applied during continuous renal replacement therapy (CRRT). Such Hct monitoring enables estimation of changes in blood volume as percentage change (ΔBV%) from therapy start time and is incorporated into intermittent haemodialysis machines but not CRRT machines despite its potential to optimise fluid management in CRRT patients.
METHODS: To overcome this problem, we used a standalone monitor (CRIT-LINE®IV, Fresenius Medical Care, Concord, USA) with an associated in-line blood chamber (CRIT-LINE®IV Blood Chamber, Fresenius Medical Care, Concord, USA) and designed our own adaptor connection piece (TekMed and Morriset, Melbourne and Brisbane, Australia) to allow these readings at the vascular access outflow and recorded data for estimated Hct and derived ΔBV% during CRRT.
RESULTS: We report on this technique with an illustrative case example and 12 h of CRRT data on the fluid loss rate prescribed, hourly net patient fluid loss (range: 0-308 mL/h), mean arterial pressure, norepinephrine dose (range: 5-14 mcg/min), estimated continuous Hct and ΔBV%, and the otherwise undetected diagnosis of an approximate 15 % decrease in blood volume during the CRRT.
CONCLUSIONS: We have described a technical CRRT circuit modification that can facilitate a previously unavailable assessment of fluid shifts during CRRT. Further application in clinical trials is now possible.
METHODS: To overcome this problem, we used a standalone monitor (CRIT-LINE®IV, Fresenius Medical Care, Concord, USA) with an associated in-line blood chamber (CRIT-LINE®IV Blood Chamber, Fresenius Medical Care, Concord, USA) and designed our own adaptor connection piece (TekMed and Morriset, Melbourne and Brisbane, Australia) to allow these readings at the vascular access outflow and recorded data for estimated Hct and derived ΔBV% during CRRT.
RESULTS: We report on this technique with an illustrative case example and 12 h of CRRT data on the fluid loss rate prescribed, hourly net patient fluid loss (range: 0-308 mL/h), mean arterial pressure, norepinephrine dose (range: 5-14 mcg/min), estimated continuous Hct and ΔBV%, and the otherwise undetected diagnosis of an approximate 15 % decrease in blood volume during the CRRT.
CONCLUSIONS: We have described a technical CRRT circuit modification that can facilitate a previously unavailable assessment of fluid shifts during CRRT. Further application in clinical trials is now possible.
摘要：
背景：持续血红蛋白，静脉血氧饱和度,和血细胞比容（Hct）监测目前不应用在连续性肾脏替代治疗（CRRT）。这样的Hct监测能够将血液体积的变化估计为从治疗开始时间起的百分比变化(ΔBV%),并且被并入间歇性血液透析机而不是CRRT机中,尽管其可能优化CRRT患者中的流体管理。
方法：为了克服这个问题，我们使用了独立的显示器(CRIT-LINE®IV，费森尤斯医疗,康科德,USA)withanassociatedin-linebloodchamber(CRIT-LINE®IVbloodchamber,费森尤斯医疗,康科德,美国）并设计了我们自己的适配器连接件（TekMed和Morriset，墨尔本和布里斯班，澳大利亚）允许在CRRT期间在血管通路流出处进行这些读数，并记录估计的Hct和得出的ΔBV%的数据。
结果：我们以说明性案例示例和12h的CRRT数据报告了该技术，每小时净患者液体损失（范围：0-308毫升/小时），平均动脉压,去甲肾上腺素剂量（范围：5-14微克/分），估计连续Hct和ΔBV%，以及在CRRT期间未检测到的血容量减少约15％的诊断。
结论：我们已经描述了一种技术性的CRRT回路修改，可以促进先前无法获得的对CRRT过程中流体移位的评估。现在可以在临床试验中进一步应用。
方法：为了克服这个问题，我们使用了独立的显示器(CRIT-LINE®IV，费森尤斯医疗,康科德,USA)withanassociatedin-linebloodchamber(CRIT-LINE®IVbloodchamber,费森尤斯医疗,康科德,美国）并设计了我们自己的适配器连接件（TekMed和Morriset，墨尔本和布里斯班，澳大利亚）允许在CRRT期间在血管通路流出处进行这些读数，并记录估计的Hct和得出的ΔBV%的数据。
结果：我们以说明性案例示例和12h的CRRT数据报告了该技术，每小时净患者液体损失（范围：0-308毫升/小时），平均动脉压,去甲肾上腺素剂量（范围：5-14微克/分），估计连续Hct和ΔBV%，以及在CRRT期间未检测到的血容量减少约15％的诊断。
结论：我们已经描述了一种技术性的CRRT回路修改，可以促进先前无法获得的对CRRT过程中流体移位的评估。现在可以在临床试验中进一步应用。
