title: Forced fluid removal in critically ill patients with acute kidney injury.
abstract: OBJECTIVE
  The aim was to test the feasibility of protocol-driven fluid removal with continuous renal replacement therapy (CRRT) in patients in whom standard fluid balance prescription did not result in substantial negative fluid balances.
  
  
  METHODS
  In 10 mechanically ventilated patients with sepsis or signs of inflammation and acute kidney injury [age 65 (48-78 years; median, range), simplified acute physiology score II 66 (39-116)], fluid removal was guided by mean arterial pressure (MAP), cardiac index (CI), mixed venous oxygen saturation (SvO(2)), lactate/base excess, peripheral circulation, and filling pressures, and adjusted hourly with the goal to maximize volume removal for up to 3 days.
  
  
  RESULTS
  Fluid removal rates during the 3 days before and during the study period [66 (36-72) h] were 11 (-30 to +36) ml/kg/day and -59 (-85 to -31) ml/kg/day, respectively (P = 0.002). In 12% of a total of 594 fluid removal rate evaluations, fluid removal had to be decreased or stopped. Most frequent reasons leading to decreasing fluid removal were (n, % of all instances, median lowest value from all patients): SvO(2) (44, 28%, 59%), MAP (36, 23%, 57 mmHg), CI (26, 17%, 2.4 l/min/m(2)), low peripheral temperature (22, 14%, 'cold'). Overall, systemic hemodynamics remained stable throughout the study period.
  
  
  CONCLUSIONS
  In these patients, protocolized fluid removal with CRRT was associated with large negative fluid balances.
authors: Department of Intensive Care Medicine, Bern University Hospital, Switzerland.
authors: C C
authors: CC
authors: Ganter
authors: R
authors: R
authors: Hochuli
authors: M
authors: M
authors: Bossard
authors: R
authors: R
authors: Etter
authors: J
authors: J
authors: Takala
authors: D E
authors: DE
authors: Uehlinger
authors: S M
authors: SM
authors: Jakob
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D001775:Blood Circulation / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D003627:Data Interpretation, Statistical; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D018805:Sepsis / Q000628:therapy
chemical_list: D010100:Oxygen