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Extended Indications 

Extended Indications
Chapter:
Extended Indications
Author(s):

Rinaldo Bellomo

and Ian Baldwin

DOI:
10.1093/med/9780190225537.003.0008
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date: 04 June 2020

CRRT can be used to achieve its logical clinical goals in extended indications using different methods. For example, if the issue at stake is that of fluid removal, standard CRRT can be used to lower the urea concentration while aiming for a significant negative fluid balance of – 200 to – 400 ml/hr. With this approach large amounts of fluid can be removed from patients with diuretic resistant fluid overload. If the patient has severe sepsis or septic shock and the goal of therapy is to remove soluble mediators, then either high-volume hemofiltration or high cut-off hemofiltration can be applied. High volume hemofiltration requires high blood flows (>300 mL/min) in order to avoid either excessive pre-dilution (if the replacement fluid is administered before the filter) or excessive hemoconcentration within the filter (if the replacement fluid is administered after the filter).

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