The evaluation of reasonable application of CRRT in ICU

OBJECTIVE: To evaluate the status of application of continuous renal replacement therapy (CRRT) in patients in the intensive care unit (ICU). METHODS: The clinical data of 171 ICU patients who had indications for CRRT in the First Affiliated Hospital of Xi'an Jiaotong University from January to December 2014 were retrospective analyzed. The patients were divided into non-CRRT group (n=23) and CRRT group (n=148) which was composed of continuous veno-venous hemofiltration (CVVH) group (n=66) and non-CVVH group (n=82). Among the 148 CRRT patients, 83 had improvement, 46 had no improvement, and 19 died. Among the 66 CVVH patients, 39 had improvement, and 27 had no improvement. The indications of the 171 patients and several aspects of the CRRT group including anticoagulation regimen, catheterization program, replacement fluid, and CRRT pipe flushing were statistically analyzed. And the correlations between the clinical data, CRRT mode, and efficacy were evaluated. RESULTS: The rate of rational indications of 171 patients was 86.55%, meanwhile the rates of the reasonability of anticoagulation method, catheterization program, replacement fluid, and CRRT pipe flushing of the CRRT group were 84.76%, 66.89%, 100%, and 100%, respectively. Single factor analysis showed that the levels of BUN (P=0.035) and creatinine (P=0.007) at baseline and the urine output on the third day (P=0.034) had statistically significant difference among the CVVH group, non-CVVH group, and non-CRRT group. There were also significant differences in the survival rate (P=0.01) and prognosis of survivals (P=0.007) in CRRT group among different catheterization programs. Multivariate analysis indicated that there was significant correlation between the lengh of stay in ICU [P=0.005, OR: 0.734, 95% CI(0. 592, 0.910)], catheterization program [P=0.016, OR: 5.302, 95%CI(1.369, 20.527)] and prognosis. CONCLUSION: The indications, anticoagulation method, and catheterization program of the CRRT group were partially unreasonable in the 171 patients in our study, and the unreasonability rates were 13.45%, 15.24%, and 33.11%, respectively. Clinical pharmacists should focus on the drug regimens and individual monitoring of ICU patients in the process of CRRT, considering their pathophysiological characteristics and complexity of medical therapeutic schemes.