Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

Fletcher, Jeffrey J.; Bergman, Karen; Feucht, Eric C.; Blostein, Paul A.

doi:10.1007/s12028-009-9197-9

Cited by 20 publications

(9 citation statements)

References 29 publications

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“…Among treatment modalities for ARF, continuous renal replacement therapy (CRRT) has shown to have a much lesser effect on intracranial pressure (ICP) than intermittent hemodialysis (IHD) 6). Additionally, some authors have reported that CRRT have an effect on lowering ICP 89). Regarding hemodynamics, CRRT can be a better treatment modality for ARF compared to IHD in severe TBI patients.…”

Section: Introductionmentioning

confidence: 99%

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury

Park

Choi

You

et al. 2016

Korean J Neurotrauma

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ObjectiveThe purpose of this study was to investigate the impact of continuous renal replacement therapy (CRRT) on survival and relevant factors in patients who underwent CRRT after traumatic brain injury (TBI).MethodsWe retrospectively reviewed the laboratory, clinical, and radiological data of 29 patients who underwent CRRT among 1,190 TBI patients treated at our institution between April 2011 and June 2015. There were 20 men and 9 women, and the mean age was 60.2 years. The mean initial Glasgow Coma Scale score was 9.2, and the mean injury severity score was 24. Kaplan-Meier method and Cox regression were used for analysis of survival and relevant factors.ResultsThe actuarial median survival time of the 29 patients was 163 days (range, 3-317). Among the above 29 patients, 22 died with a median survival time of 8 days (range, 3-55). The causes of death were TBI-related in 8, sepsis due to pneumonia or acute respiratory distress syndrome (ARDS) in 4, and multi-organ failure in 10. Among the various factors, urine quantity of more than 500 mL for 24-hours before receiving CRRT was a significant and favorable factor for survival in the multivariate analysis (p=0.026).ConclusionAccording to our results, we suggest that early intervention with CRRT may be beneficial in the treatment of TBI patients with impending acute renal failure (ARF). To define the therapeutic advantages of early CRRT in the TBI patients with ARF, a well-designed and controlled study with more cases is required.

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Section: Introductionmentioning

confidence: 99%

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury

Park

Choi

You

et al. 2016

Korean J Neurotrauma

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“…Potential protective strategies against DDS have been proposed in the literature, including slower blood and dialysate flows, smaller surface area dialyzer membranes, and high sodium and low bicarbonate concentrations in the dialysate [14]. Furthermore, continuous therapies (i.e., CRRT) have been suggested as being safer than intermittent hemodialysis in patients at risk of DDS [15, 16]. The common rationale behind these strategies is to slow down the rate of urea clearance, to reduce the change in serum osmolality, and to maintain hemodynamic stability.…”

Section: Discussionmentioning

confidence: 99%

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

Lund

Damholt

Strange

et al. 2017

Case Reports in Critical Care

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Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

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“…(32,33) Additionally, there is anecdotal evidence that CRRT may have beneficial effects in patients with refractory intracranial hypertension. (34) The disadvantage of any CRRT is the use of anticoagulation, wherein there are risks of intracerebral hemorrhage. However, we did not employ anticoagulants in the presented cases.…”

Section: Discussionmentioning

confidence: 99%

High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

Cornejo¹,

Romero²,

Ugalde³

et al. 2014

Revista Brasileira De Terapia Intensiva

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We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.

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Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

Abstract: Though unproven, CRRT may be beneficial in patients with IH due to gentle removal of fluid, solutes, and inflammatory cytokines. Given the limited data on safety of CRRT in patients with ABI, we encourage further reports.

Cited by 20 publications

References 29 publications

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

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