Gestion pratique de l'épuration extrarénale continue au quotidien

The incorporation of findings based on two recently published studies into daily clinical practice in continuous venovenous haemofiltration (CVVH) in 2008 can now be deemed to be urgent. These studies highlight the crucial role of adequate dosage of CVVH, whereby a dose of 35 mL/kg per hour was associated, in critically ill patients in renal failure, with dramatic improvement and survival of nearly 20%. These two studies provide the best currently available evidence, though the results of other confirmatory (or not as the case may be) studies still ongoing are awaited. In a world increasingly guided by Evidence Based Medicine, two level I studies will lead to a Grade A recommendation, which should therefore be applied by every intensivist instigating continuous haemofiltration, while awaiting the results of the ongoing studies.Nevertheless, the implementation process in the daily practice of intensive care medicine will have to overcome a number of potential difficulties. These encompass items as blood flow requirements, vascular access problems, pre- and postdilution policy, type of membranes used as well as restitution fluid and the possible need for associated dialysis, to name the most important ones. This paper will describe in detail, from a strictly practical basis, how to implement these changes in routine daily practice at the ICU bedside. These implementations will obviously necessitate a collaborative network between medical staff members and the entire nursing staff.