Continuous Renal Replacement Therapies: Raising the Bar for Quality Care

摘要

Continuous renal replacement therapy (CRRT) has become a standard therapy option and has been widely used for critically ill patients requiring renal support since it was introduced 4 decades ago. Patients requiring CRRT are typically at high risk of death related to their severity of illness, and mortality rates in this population have remained steady around 50% since the advent of CRRT. The advances in CRRT hemofilter supplies and device technologies in the past 2 decades aimed to improve safety and quality in delivery of this therapy. Despite these improvements, the variability in CRRT practice has been implicated as a potential contributing factor in morbidity and mortality outcomes for patients receiving this therapy. Patients who require CRRT are especially vulnerable for poor outcomes because of the severity of their critical illness, which potentially limits their resiliency to standard practice breaches and related complications. This symposium is intended to increase awareness and knowledge of best-practice strategies for safe and high-quality CRRT care that improve patients' outcomes. The articles in this symposium present a review of best-practice quality recommendations for CRRT, including recommendations from a recent expert consensus conference, a model for CRRT training and competency evaluation that expands beyond initial orientation, an overview of considerations for medication management during CRRT, and a series of 3 case vignettes that highlight different applications of CRRT that are based on patient-specific goals of therapy.