Foot Steps on Dialysis
Acute renal failure (ARF) occurs in approximately 10–15% of hospitalized patients, while its incidence in the intensive care unit (ICU) has been reported in more than 50% of patients. Renal replacement therapy (RRT) plays an important role in the treatment of severe AKI. Intermittent hemodialysis (HD) and continuous hemodialysis (CVHD) are the main modalities in critically ill patients with ARF. Continuous hemodialysis has been the preferred modality in many countries due to its purported superiority in both hemodynamic tolerance and recovery of renal function.
Most patients with AKI require the insertion of a temporary, non-tunneled HD catheter. The most frequently described and worrisome catheter-related complications are: hematomas, hemorrhages, infections, vein thrombosis, stenosis, air embolism, catheter displacement. Early physical therapy is crucial in the management of critically ill patients and is associated with a decrease in the syndrome after ICU stay, frailty, and length of hospital stay. These patients are usually bedridden to avoid catheter-related complications.
Data from the literature demonstrate that early mobilization is safe and is associated with lower rates of adverse events. The increase in filter life in the femoral catheter group was demonstrated by literature. It was showed that in-hospital mortality was lower for patients who walked (17.95% vs. 73.53%) in those who did not receive the therapy. Patients should be selected by the multidisciplinary team, physician and physical therapist of the ICU, with well-defined inclusion criteria such as: being able to understand and execute commands properly, opening the eyes after verbal stimulation, being hospitalized in a clinical or surgical ICU for at least 72 hours, breathing spontaneously; absence of intracranial hypertension, with hemodynamic stability (defined as SBP > 90 mmHg and < 170 mm HG) and respiratory (preferably with oxygen saturation SpO2 > 90%, fraction of inspired oxygen ≤ 60% and respiratory rate < 25rpm). Exclusion criteria: hemodynamic changes, use of vasopressors, fever, agitation, coma, heart rate < 40 bpm and >130 bpm; systolic blood pressure (SBP) < 90mmHg and >180mmHg; mean arterial pressure <60mmHg and >110mmHg. respiratory rate < 5 rpm and >40 rpm; and peripheral oxygen saturation >88%. These studies were similar with the use of continuous venovenous hemodiafiltration (CVVHDF, Prismaflex at a dial rate). In our center of dialysis, CND (Nephrology and Dialysis Center of the Ernesto Dornelles Hospital de POA), has experience with this type of care physiotherapy since 2016, with more than 20 patients, without complications or adverse events worth noting, such as: catheter displacement, bleeding, thrombosis, arrhythmias, death, among others. A research project was forwarded to the institution's CEP where several parameters will be analyzed (patient, machine, catheter, for effects, outcomes including length of ICU stay, discharge and death). We share this experience that aims to improve the patient's quality of life, which we believe impacts hospitalization time and complications secondary to functionality. We need to explore tje patient experience.
Visit the ISN Community Film Event website
https://www.theisn.org/wcn/isn-commun...