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Continuous renal replacement therapy (CRRT) in children

Published on March 30, 2021   45 min

A selection of talks on Clinical Practice

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0:00
Good morning, this is Dr. Tim Bunchman, I'm a pediatric nephrologist at Virginia Commonwealth University of Medicine. My talk today is on CRRT, which is Continuous Renal Replacement Therapy in children.
0:14
My talk today will talk about things relative to CRRT, including vascular access, solutions, anticoagulation, nutrition, drug clearance, as well as utilization and timing of CRRT.
0:29
To understand CRRT, one has to understand the terminology. The concept of convection is a way (by mass transport) to put a solution that's sterile into the vascular space (either pre- or post-filter) and to, if you will, 'shove' the solute across the membrane by convection.
0:49
In this next slide, we have a caricature of the same issue. Convective clearance is called CVVH, and you're using a physiologic sterile solution, either post-filter (which has often happened in Australia) or pre-filter (which happens mostly in Europe and North America) to shove, if you will, or move solute across the membrane. That is CVVH or convective clearance.
1:14
Diffusive clearance is that same model but you've got dialysate on the outside of the vascular space, setting up a gradient of which solute comes across, secondary to a gradient concept.
1:27
CVVHD, hemodialysis, peritoneal dialysis, and a note that I don't have on this slide, SLED (which is slower low efficiency dialysis), is all diffusion. The concept of diffusion is that you have a sterile solution across a membrane, across from the blood space, that solute clears by a gradient.

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Continuous renal replacement therapy (CRRT) in children

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