Abstract
Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.
Highlights
Acute brain injury (ABI) is the sudden and reversible loss of brain autoregulation capacity as a consequence of a disruption of the blood-brain barrier (BBB) that conditions metabolic and inflammatory alterations that lead to cerebral edema and increased intracerebral pressure (ICP) [1]
One of the most widely used modalities in the context of critical care patients is continuous venovenous hemofiltration (CVVH), this technique allows a gradual reduction in the concentration of uremic toxins and fluids, avoiding sudden changes in serum osmolality and favoring hemodynamic stability, advantages that give it superiority over intermittent hemodialysis in the context of the patient with ABI
The Kidney Disease Improving Global Outcomes (KDIGO) group recommends a EFV of 20 - 25 ml/Kg/h; since there is a difference between the effective dose and the prescribed dose, a dose of 30 35 ml/Kg/h is proposed to achieve the proposed objective that has been related to better outcomes [27–29]
Summary
Reviewed by: Sara Samoni, Sant’Anna School of Advanced Studies, Italy Renhua Lu, Shanghai JiaoTong University, China. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury.
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