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
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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)