Preparedness of Kidney Replacement Therapy in the Critically Ill During COVID-19 Surge

摘要

(a) Overview of a stepwise plan from conventional to contingency and crisis plan operations for the provision of kidney replacement therapy (KRT) during surge of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU). (b) Specific allocation of KRT resources to support the stepwise plan of operations. Plan A denotes conventional/standard operations. Plan B (contingency) denotes rotation of continuous renal replacement therapy (CRRT) or hemodialysis (HD) machines between network institutions based on KRT load balance requirements. Plan C (contingency) denotes combining 24-hour CRRT and shift-based CRRT (<12 hours per patient-day) in 24-hour KRT cycles based on individual patient needs and KRT load balance requirements (e.g., some CRRT machines will perform KRT on 2 or more patients per day). Plan D (contingency/crisis) denotes adding prolonged intermittent renal replacement therapy (PIRRT) (approximately 6–8 hours per treatment) as an alternative modality of KRT in the ICU. Plan E (crisis) denotes systematic utilization of all aforementioned KRT modalities plus the addition of acute peritoneal dialysis (PD) as an alternative modality of KRT for selected patients.