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Title: Haematocrit monitoring and blood volume estimation during continuous renal replacement therapy.
Austin Authors: Baldwin, Ian C ;Maeda, Akinori;Bellomo, Rinaldo ;See, Emily J 
Affiliation: Intensive Care
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
Issue Date: Jul-2024
Date: 2024
Publication information: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses 2024-07; 37(4)
Abstract: Continuous haemoglobin, venous blood oxygen saturation, and haematocrit (Hct) monitoring is currently not applied during continuous renal replacement therapy (CRRT). Such Hct monitoring enables estimation of changes in blood volume as percentage change (ΔBV%) from therapy start time and is incorporated into intermittent haemodialysis machines but not CRRT machines despite its potential to optimise fluid management in CRRT patients. To overcome this problem, we used a standalone monitor (CRIT-LINE®IV, Fresenius Medical Care, Concord, USA) with an associated in-line blood chamber (CRIT-LINE®IV Blood Chamber, Fresenius Medical Care, Concord, USA) and designed our own adaptor connection piece (TekMed and Morriset, Melbourne and Brisbane, Australia) to allow these readings at the vascular access outflow and recorded data for estimated Hct and derived ΔBV% during CRRT. We report on this technique with an illustrative case example and 12 h of CRRT data on the fluid loss rate prescribed, hourly net patient fluid loss (range: 0-308 mL/h), mean arterial pressure, norepinephrine dose (range: 5-14 mcg/min), estimated continuous Hct and ΔBV%, and the otherwise undetected diagnosis of an approximate 15 % decrease in blood volume during the CRRT. We have described a technical CRRT circuit modification that can facilitate a previously unavailable assessment of fluid shifts during CRRT. Further application in clinical trials is now possible.
DOI: 10.1016/j.aucc.2023.11.005
Journal: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
PubMed URL: 38245397
Type: Journal Article
Subjects: Acute kidney injury
Fluid balance
Net ultrafiltration rate
Relative blood volume
Appears in Collections:Journal articles

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