Initiation time of continuous renal replacement therapy on patients with acute respiratory distress syndrome

Meng Li-jun; Liu Wei-li

doi:10.3969/j.issn.1002-1949.2018.01.015

Abstract：Objective To investigate the optimal time of initiation of continuous renal replacement therapy (CRRT) in patients with acute respiratory distress syndrome (ARDS).Methods Forty-eight patients with ARDS were randomly divided into two groups: early CRRT group ( within 24 hours after ARDS onset ) and late CRRT group ( 24 hours after ARDS onset ) .Ventilation parameter , including PaO2/FiO2 , positive end expiratory pressure ( PEEP ) , plateau pressure ( Pplat ) and hemodynamic parameters including central venous pressure ( CVP ) , mean arterial pressure ( MAP ) , blood lactic acid ( Lac) between the early and the late CRRT groups were observed at the time points of 0 h, 2 days later and 7 days later.Fluid balance, the duration of total mechanical ventilation , intensive care unit ( ICU) stay, and the 28-day mortality rate were assessed .Results There were statistical increases in PaO2/FiO2 , MAP and statistical decreases in PEEP , Pplat, Lac, and CVP from 2 days after the treatment in the patients of the early CRRT group .Furthermore, there were significantly differences in those indicators between two groups at 2 days and 7 days.The duration of total mechanical ventilation and ICU stay of the early CRRT group were (8.5 ±3.1) days and (12 ±2) days respectively, both significantly shorter than that of the late CRRT group [(14.4 ±4.1) days and (19 ±5) days,P<0.05].The 28 -day mortality rate between the two groups were 20.83 ％ vs37.5％(P <00.5). Conclusion CRRT within 24 hours can improve oxygenation , shorten the duration of mechanical ventilation and ICU stay , decrease mortality in ARDS patients, and is associated with favorable clinical outcomes in ARDS patients .