Is the time right for CRRT, and who should provide it?
A 42-y/o man is emergently cannulated for VV ECMO for ARDS and develops oliguria. His labs after several hours reveal a BUN of 32 mg/dL and creatinine of 0.9 mg/dL. On a flow of ~ 5 L/min and 100% oxygen his pH is 7.35 and lactate is 1.8. He has made only 20 ml/hr of urine output over 5 hours. There is minimal improvement with a diuretic challenge and the patient is already 3 liters positive in fluid balance. Is it time to start him on CRRT? Should it be started now by the intensivist or can it wait until tomorrow when the nephrologist arrives. What is the evidence for starting RRT early and should this be a procedure provided exclusively by nephrologists? Read the discussion and let us know what you would have done.
Summary provided by Rajit Basu, MD, MS
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