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.
