(duplicate) Can a calculator improve renal replacement therapy?
Research type
Research Study
Full title
Can a calculator enable clinicians to deliver the best renal replacement therapy?
IRAS ID
154493
Contact name
Stephen Mousdale
Contact email
Sponsor organisation
East Lancashire Hospitals NHS Trust
Research summary
Can a spreadsheet calculator enable clinicians to deliver the best evidenced renal replacement therapy to critically ill patients?
Continuous veno-venous haemodialfiltration (CVVHDF) is performed when critically ill patients suffer renal failure. Blood is pumped from a vein, through a filter to remove urea, creatinine, electrolytes and impurities and pumped back into a vein. A counter-current of fluid is passed through the filter to improve the removal of impurities (dialysis). Fluid that is removed is replaced with a standard electrolyte solution.
It is now generally accepted that in patients receiving CVVHDF the total effluent flow rate from the filter and the dialysis expressed in ml/kg/hr represents the dose of CVVHDF. A large trial which showed that optimum survival benefit could be achieved with effluent flow rates of 25ml/kg/hr.
In our institution audit showed that our previous ad hoc practice failed to deliver 25ml/kg/hr CVVHDF. We developed a spreadsheet calculator that tells the clinicians and nurses the optimal fluid flow rates to deliver 25ml/kg/hr for any given patient. This should reduce the gap between the theoretical delivery of the dose and the practical aspects of programming the filtration device (Prismaflex), it will ensure that all of our critically ill patients receive the optimum evidence based therapy and it should optimise machine performance. Improvements in circuit performance and longevity would have beneficial effects in terms of cost.
To test this hypothesis we wish to undertake a prospective evaluation of our service improvement. Critically ill patients on our Critical Care unit now receive CVVHDF that is prescribed using our calculator. Using data from the electronic log on the filter machine, we will assess if we now deliver 25ml/kg/hr of CVVHDF and if we have reduced the variance in practice, as compared to data from patients that were treated before the calculator was developed.
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
14/YH/1004
Date of REC Opinion
30 May 2014
REC opinion
Favourable Opinion