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Optimizing continuous renal replacement therapy in the ICU

a team strategy

Joannes-Boyau, Oliviera; Velly, Lionelb; Ichai, Carolec

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 476–482
doi: 10.1097/MCC.0000000000000564
RENAL SYSTEM: Edited by Thomas Rimmelé

Purpose of review The consideration of acute kidney injury, its incidence and its impact on the outcome of patients has grown continuously in recent years, leading to an increase in the use of renal replacement therapy (RRT) techniques. However, the successful conduct of RRT depends on the effectiveness of the entire team, doctors and nurses. It is therefore important to know the essential elements to be implemented in the ICU to ensure optimal RRT.

Recent findings Recent studies show that the successful conduct of a RRT session requires a good knowledge of the principles of the technique, regular basic training, identification of experts, drafting clear and well followed protocols and good communication between the various stakeholders. In addition, the use of the latest advances, such as regional citrate anticoagulation, allows further optimization of therapy, only if, again, both physicians and nurses are properly trained and highly involved.

Summary We now have a better understanding of the measures to be deployed to optimize RRT. Organization, training, evaluation and protocols are the key points of the team's efficiency for a safe and effective implementation of RRT.

aService d’Anesthésie-Réanimation SUD, Hôpital Magellan, CHU de Bordeaux, Bordeaux, France

bDepartment of Anesthesiology and Critical Care Medicine, Institut de Neuroscience de la Timone (INT), Aix Marseille University, University Hospital La Timone, Marseille, France

cDepartment of Anesthesiology and Critical Care Medicine, Université Côte d’Azur, CHU de Nice, Hôpital Pasteur 2, Nice, France

Correspondence to Olivier Joannes-Boyau, MD, Service d’Anesthésie-Réanimation SUD, Hôpital Magellan, CHU de Bordeaux, Avenue Magellan, 33600 Pessac, Bordeaux, France. Tel: +33 557656866; e-mail:

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