A 34-year-old female with a history of hypertension and diabetes is admitted to the ICU after an exploratory laparotomy following a motor vehicle accident. Her vital signs include HR 110 bpm and BP 90/66 mm Hg. She is currently intubated and mechanically ventilated and has developed AKI requires RRT. It is anticipated that she would need several trips to the operating room in the next few days for debridement and subsequent closure of the abdomen.
Which of the following would be the MOST efficient modality of RRT in this patient?
A. Continuous renal replacement therapy (CRRT)Correct Answer: B
PIRRT is a renal replacement modality wherein treatment sessions last over 8 to 12 hours but are intermittent (about three times a week). It is a hybrid treatment wherein the hemodynamic stability achieved with CRRT is combined with the intermittent nature of IHD. Diffusion, convection, or a combination of the two techniques could be used with this modality. It is especially useful in patients who are not hemodynamically stable enough to initiate IHD but require several interruptions in therapy (potentially due to required procedures) which would make provision for CRRT challenging. To be effective, CRRT needs to be performed over 24 hours with minimal interruptions. As PIRRT has scheduled time off of dialysis and anticoagulation, procedures could be strategically scheduled over those times. PIRRT is sometimes referred to as sustained low-efficiency (daily) dialysis (SLEDD), sustained low-efficiency (daily) diafiltration (SLEDD-f), extended daily dialysis (EDD), or slow continuous dialysis (SCD). SCUF exclusively removes fluid and would be ineffective in patients requiring solute clearance as well. PIRRT is an effective hybrid renal replacement modality in hemodynamically unstable patients who are anticipated to have interruptions in CRRT.
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