L'eau de dialyse en réanimation

Although comparable to continuous hemofiltration in terms of mortality or hemodynamic stability, intermittent haemodialysis is underused in intensive care units. Water quality is a key factor for haemodialysis biocompatibility. Backdiffusion of dialysate makes the good observance of official quality recommendations regarding microbiology and chemistry necessary. As specific guidelines for dialysis water quality in intensive care are lacking, one should refer to chronic dialysis standards. For on-line haemofiltration, more strict criteria have to be met for ultrapure dialysate and reinfusion. Water treatment systems could be portable or integrated in a dialysis loop. All of them contain prefiltration, softener, filtration and reverse osmosis. For production of ultrapure dialysate, modern dialysis machines incorporate an additional step for filtration of water osmosis or dialysate. In the water system of a dialysis chain, the clean side of reverse osmosis, distribution piping, inlet lines to dialysis machine and the dialysis machines themselves are included. The use of different components that comply to the European standards is a warranty of chemical and bacteriological purity. Weak links of the water chain are often located at connexions between the different devices or due to partial compliance in maintenance and disinfection procedures. Multidisciplinary conception and practice of strict usage rules, disinfection, maintenance and control procedures are indispensable for qualification phase of dialysis treatment system. Over time, success in achieving dialysate purity relies on a quality insurance process that involves all intensive care unit staff members, and requires strict protocols, a permanent documentation of results and quick corrective actions when results deviate from their norm. Biocompatibility is the prerequisite for haemodialysis in intensive care unit and is achieved by frequent and regular use of all the dialysis water treatment chain.