Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Critical Care, Oct 2016

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://ccforum.com/content/pdf/s13054-016-1456-5.pdf

Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Viale Rodolfi Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications Gianluca Villa 0 Mauro Neri 0 Rinaldo Bellomo Jorge Cerda A. Raffaele De Gaudio Silvia De Rosa 0 Francesco Garzotto 0 Patrick M. Honore John Kellum Anna Lorenzin 0 Didier Payen Zaccaria Ricci Sara Samoni Jean-Louis Vincent Julia Wendon Marta Zaccaria 0 Claudio Ronco 0 on behalf of the Nomenclature Standardization Initiative (NSI) Alliance 0 Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital , Viale Rodolfi 37, 36100 Vicenza , Italy This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis. Terminology; Pump; Pressure sensor; CRRT machine; Continuous veno-venous hemodialysis; Continuous veno-venous hemofiltration; Continuous veno-venous hemodiafiltration; High volume hemofiltration; Continuous plasmafiltration coupled with adsorption; Hemoperfusion - Background The use of renal replacement therapy (RRT) in the management of acute kidney injury (AKI) requires a multidisciplinary approach. It is, therefore, essential that all members of the team use the same terminology, but the terms used to describe the different modalities of RRT often vary and can be confusing. In this article, we provide an updated consensus nomenclature to help navigate this complex field. We review the practical applications of transmembrane solute and fluid transport principles and the control mechanisms for RRT devices. The article focuses on continuous renal replacement therapies (CRRTs), which are commonly used in the treatment of critically ill patients. We hope that this standardized terminology will be adopted by all involved in this field, including industry as they develop new devices. Methodology A conference was organized in Vicenza, Italy, to gather experts in CRRT and members of companies manufacturing CRRT hardware and devices to establish consensus on technical terminology and definitions relevant to basic principles of CRRT and related technologies [1]. The conference provided the background for a modified Delphi consensus methodology as previously utilized for the Acute Disease Quality initiative consensus sessions [2]. Prior to the conference, participants screened the literature of the last 25 years and previous taxonomy efforts [3–5]. Keywords included “continuous renal replacement therapy”, “dialysis”, “hemofiltration”, “convection”, “diffusion”, “ultrafiltration”, “dose”, “blood purification”, “renal support”, “multiorgan dysfunction”, together with the relative MeSH (Medical Subject Headings) terms. Abstracts of 707 articles were screened and more than 300 papers were read in full and analyzed. Based on this literature search, a series of definitions and terms were proposed and consensus was achieved from the majority of experts who participated in the conference. Where consensus was lacking, different statements were created after two-thirds of the audience expressed a positive vote. We present the results of this effort of terminology harmonization called the Nomenclature Standardization Initiative (NSI). Hardware and devices CRRT “hardware” includes the machine and all dedicated disposables. Knowledge of the nomenclature and the functions of the machine and its main components is extremely important, not only for nurses and technicians but also for clinicians. Figure 1 depicts a standard CRRT machine equipped with current technology and characteristics [6, 7]. Its main components include: 1. Screen: the monitor through which the user interacts with the machine. 2. Alarm light and sound indicators: visual and auditory alarms must be clear and comprehensive. The alarm settings should be unequivocally categorized according to a specific standard. 3. In-flow pressure (PIN) sensor (ups (...truncated)


This is a preview of a remote PDF: http://ccforum.com/content/pdf/s13054-016-1456-5.pdf

Gianluca Villa, Mauro Neri, Rinaldo Bellomo, Jorge Cerda, A. De Gaudio, Silvia De Rosa, Francesco Garzotto, Patrick Honore, John Kellum, Anna Lorenzin, Didier Payen, Zaccaria Ricci, Sara Samoni, Jean-Louis Vincent, Julia Wendon, Marta Zaccaria, Claudio Ronco, . Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications, Critical Care, 2016, pp. 283, 20, DOI: 10.1186/s13054-016-1456-5