Let me preface by saying that I believe far too many patients that are in ICU's are paired, and that CRRT should be a 1:1. Otherwise, the patients are not getting the quality of care they need or deserve.
That said, forgive me for the following rant and feel free to skip to the next posting- I am also becoming convinced that we are using CRRT too late in the game due to the propensity of renal docs to bend toward traditional dialysis for whatever reason, (comfort with technology, reimbursement, etc.) I had to do some research on the subject lately, and in Italy and Australia the propensity is toward putting patients on the machines earlier. The patient outcomes are better and renal recovery more likely in the studies I've seen. Granted, there are flaws and the populations are small, but it does deserve a closer look. Think about it- You have a patient in the early phase of sepsis, the kidney's are showing insufficiency and we watch them. We give nephrotoxic antibiotics and we watch them. We put them on pressors because they are not perfusing and we watch them. Now we are in renal failure and maybe we should think about dialysis, but they are hemodynamically unstable so let's put them on CRRT. Maybe, when the kidney's were telling us they needed help, we could have at least mitigated some of the damage done by the disease process. Proactive instead of reactive therapy.- Just a thought