Has anyone EVER seen a patient come off CRRT alive?

[rph3664]

The hospital where I work recently hired a nephrologist who sometimes orders this. We have NEVER seen a patient who had this treatment leave the hospital alive; the fact that they were moribund when they went on this may be a factor but we're all thinking that SOMEONE must have had this treatment and gone home afterwards or they wouldn't order it.

Anyone wish to comment?

[BBFRN, BSN, PhD]

I had a pt on CRRT the other day. His renal function improved after 3 days on it, we transferred him to TCU several hours later, and he is now home. He was originally a post-CABG x 4, and went into renal failure 1 day post-op.

[kessadawn, BSN, RN]

our picu uses crrt, sometimes we don't use it for a while, then all of a sudden we get several kids in a row who need it. they're using it in our burn center too. our kids more often than not recover, and maybe it's having to do with the fact that their primary dx usually doesn't concern kidneys or the like. maybe the pts you've had on crrt are a whole lot sicker than our kiddos, and for different reasons.

just my 2 cents:)

[rph3664]

These are usually ordered for the patients of a certain heart surgeon that I, and a lot of other people, believe does things to his patients to make them have complications so he can "rescue" them.

My hospital recently had a moratorium on heart surgery and everyone was really hush-hush as to why.

[km5v6r, EdD, RN]

I have seen both adult and pediatric pt's survive CRRT. Granted the ones that don't far out number the ones that do but some do survive; especailly with the adults. We currently have several peds liver/sm bowel transplant pts that have required CRRT at some point in the past. It seems to go in cycles.

[AnnieOaklyRN, BSN, RN, EMT-P]

sorry to butt in here, but I am a student. Can someone explain what CRRT is? Thanks for your time

Swtooth

[km5v6r, EdD, RN]

CRRT is continous renal replacement therapy. It is a long slow dialysis. Pt's in renal failure, either acute or chronic, who are to unstable to tolerate hemodialysis may be started on CRRT. Instead of being done in 3-4 hours the treatment ideally runs over 24 hours. I tell families that hemodialysis is like doing metabolic areobics, fluid is shifted rapidly, waste products are removed etc. CRRT is like doing a brisk walk. The waste and fluid is still removed but over a longer period of time. Someone who can't tolerate an areobics may tolerate a walk. Either way it is a sign that another organ system has failed.

[koyeh]

We do quite a bit of CRRT and they are starting to do it earlier and the sucess rate has improved. Yes people make it.

[BULLYDAWGRN, RN]

I've seen several pt's make it off CRRT in the past yr, but looking back I do recall a fair number of pt's that did'nt make it. But like the previous post, they were pretty wasted prior to the start of therapy. I think the last pt I took care of while getting the tx died within 12-16hrs of the start of the therapy.

[dayshiftnurse]

i've seen a young guy ~ 30 years old, married with a kid, --pt was in liver failure 2' to drug overdose, subsequent renal failure and was being prioritized for liver transplant. in the meantime started on crrt and then went onto hd, and renals started to recover, liver was recovering. plans for transplant, i believe, was cancelled and he eventually went home.

[PMFB-RN, RN]

Sure, almost all our CRRT patients recover and leave alive. Maybbe your docs are putting them on too late.

[Chisca, RN]

In multi system organ failure- very few come off, but if this is the type of patient you typically see you might have the opinion it is a futile gesture. In hepatorenal failure, where the kidneys have failed due to the liver failure, I have seen it save many people until they received a liver transplant. Since it is used when a patients blood pressure is too low to tolerate hemodialysis you see all the other therapies that tend to be associated with a failing body- mechanical ventilation, vasoactive drugs,

invasive hemodynamic monitoring.