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. 2019 Oct:53:236-243.
doi: 10.1016/j.jcrc.2019.06.031. Epub 2019 Jun 29.

Feasibility of a protocol to wean patients from continuous renal replacement therapy: A retrospective pilot observation

Julia-Marie Tourneur  1 , Carsten Weissbrich  1 , Christian Putensen  1 , Tobias Hilbert  2
Affiliations

Feasibility of a protocol to wean patients from continuous renal replacement therapy: A retrospective pilot observation

Julia-Marie Tourneur et al. J Crit Care. 2019 Oct.

Abstract

Purpose: To evaluate the feasibility of a protocol-based algorithm to wean acute kidney injury (AKI) patients from continuous renal replacement therapy (CRRT).

Methods: The protocol was introduced on one of two similarly equipped ICUs, while on the other (reference) ICU, CRRT discontinuation was based on clinical judgement. Patients were allocated to either ICU and were subjected to physician- or protocol-directed weaning, respectively. According to the algorithm, periodical withdrawal trials (WTs) were mandatory. Interventions were recommended (administration of diuretics, fluid, vasopressors, inotropes, or human albumin) to achieve specific goals (sufficient urine output, balanced fluid status, adequate renal perfusion pressure, optimal oxygen delivery, normoalbuminemia). Clearly stated criteria defined when to abort a WT and to resume RRT for one cycle, followed by another WT.

Results: Urine output and ScvO2 during WTs were higher with protocol-directed weaning, as well as the amount of administered fluids. WT abort ratio was 48% with a tendency to prolonged WT duration, compared to 64% in the reference patients. No relevant adverse side effects were observed.

Conclusion: Our data show the feasibility of a structured approach to wean AKI patients from RRT that bundles established interventions and brings the weaning into the physician's focus.

Keywords: Acute kidney injury; Algorithm; Renal replacement therapy; Weaning protocol.

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