机译
肾脏科医生在重症监护病房中的作用
摘要：In 1998, Drs. Claudio Ronco and Ronaldo Bellomo published an article in Nephrology, Dialysis and Transplantation (NDT) entitled “Critical Care Nephrology: the time has come” []; in that article they advocated for improvements in the multifaceted care of critically ill patients with kidney disease by promoting more training, enhanced collaboration, and improved clinical interactions between specialties. Today —almost 2 decades later— the need for nephrology expertise in the care of critically ill patients is more important than ever; yet it is uncertain whether the collaboration and training envisioned by Drs. Ronco and Bellomo have been adequately realized.Critically ill patients are surviving despite the enhanced severity of their illness, and our understanding about the epidemiology and pathophysiology of acute kidney injury (AKI) has changed in such manner that AKI is no longer thought as a marker of the death process, but instead, an active contributor to this process []. The role and methods of renal replacement therapy (RRT) has greatly expanded allowing for provision of effective therapies with less complications. RRT is no longer used as a last resort for indications such as severe uremia; instead, earlier support affords the ability to maintain fluid, acid/base and electrolyte homeostasis during critical illness []. Critical Care Nephrology has become an established specialty, with teams that perform research, clinical care, and education strictly in this arena. Great strides have been made through ongoing collaborations between critical care physicians and nephrologist to improve the way we care for patients in the ICU, educate multi-disciplinary team members, and build programs designed to maximize the delivery of care.Unfortunately, there is great variability in the care for critically ill patients with AKI, with large variations across institutions, as the field lacks consensus on how and when to begin RRT in ICU patients [–]. Many institutions have less-than-ideal collaborations between nephrologists and intensivists, some programs fail to offer adequate educational training of nurses, and only a few programs have incorporated quality improvement programs designed to maximize the effectiveness and minimize complications of RRT delivery.With the rapid growth of critical care medicine, the role of the nephrologist in the ICU has evolved. He/she must possess the necessary knowledge-base to practice effectively in the ICU, lead education efforts to optimize care, and we suggest that the nephrologist is the best representative to ensure that the programmatic aspects of RRT are optimized. This special article will provide insights into the role of nephrologist as the leader of the acute care nephrology program, highlight the role of the nephrologist as clinician for critically ill patients, and argue that nephrologists must help educate all members of the team who provide care to these vulnerable patients ( and ).Role of the nephrologist in the ICU
