Résumé
L’impact de l’utilisation d’une technique d’épuration extrarénale (EER) continue ou intermittente en termes de survie, de récupération de la fonction rénale et de tolérance hémodynamique n’est pas établi, y compris chez les patients en défaillance multiviscérale dans un contexte de sepsis. Les objectifs de l’EER en réanimation sont la correction des désordres hydroélectrolytiques, la clairance de l’urée et le contrôle de la balance hydrique. Ces objectifs doivent s’adapter aux besoins du patient. La tolérance hémodynamique est primordiale pour assurer ces objectifs. Des réglages adaptés permettent l’utilisation de l’hémodialyse intermittente, même chez les patients les plus instables.
Abstract
The best choice of renal replacement therapy technique remains debated in critically ill patients. There is no evidence that this choice impacts on survival, adverse events or renal recovery. The objectives of renal replacement therapy are the correction of metabolic disturbances, the prevention of uremic syndrome and the management fluid balance. These objectives should fit to patient’s needs. Hemodynamic tolerance must be optimized to reach these objectives. If adequate settings are selected, intermittent hemodialysis can be safely applied even in the most severe septic patients.
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Commereuc, M., Schortgen, F. Défaillance rénale au cours du sepsis : quand et comment je débute l’EER ?. Méd. Intensive Réa 26, 449–455 (2017). https://doi.org/10.1007/s13546-017-1307-7
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DOI: https://doi.org/10.1007/s13546-017-1307-7