Table 4 Studies investigating the influence of running RRT and/or catheter location on TPTD
Author | No. of patients | RRT | CVC | Dialysis Cath. Loc. | Blood flow (mL/min) | Summary of main findings | Effect dialysis cath. location | Recommendation |
|---|---|---|---|---|---|---|---|---|
Mason et al. [5] | 26 | CVVH | – | – | – | Running CVVH | n.d. | Measurements should be made with CVVH temporarily switched |
Underestimates CO and ITBV | ||||||||
Overestimates EVLWI | ||||||||
No correlation between CVVH pump speed, fluid exchange rate or use of inotropes/pressors and the changes in cardiovascular parameter on and off CVVH | ||||||||
Martinez-Simon et al. [4] | 1 | CVVHD | SVC distal lumen of a three lumen dialysis catheter | SVC | – | Running RRT | +* | RRT should be made with paused RRT |
Reduces CI and ITBVI | ||||||||
Sakka et al. [10] | 24 | CVVHF | SVC | SVC, IVC | 80–150 | Running RRT | –** | RRT should not be paused |
Associated with a significant, but clinically not relevant decrease in CI and ITBVI | ||||||||
No influence on EVLWI | ||||||||
No significantly different influence of the dialysis catheter tip position on the changes by RRT in CI, ITBVI and EVLWI | ||||||||
As a marker of good acquisition quality, variability of results was more pronounced between patients than between time points | ||||||||
Neirynck et al. [6] | 9 | CVVH | SVC | IVC (dialysis catheter before injection site) = “correct” Dialysis catheter position between the thermodilution injection and detection sites = “faulty” | – | During RRT | +* | – |
CI and GEDVI decrease | ||||||||
EVLWI increases | ||||||||
Van Craenenbroeck et al. [8] | 29 | CVVH | SVC | IVC (dialysis catheter before injection site) = “correct” Dialysis catheter position between the thermodilution injection and detection sites = “faulty” | 130 ± 35 | During RRT | +* | “Ideally, optimal (hemodynamic) management should be based on the parameters obtained without CVVH” |
Drop in CI and GEDVI | ||||||||
Increase in EVLWI | ||||||||
Drop in CI and GEDVI and increases in EVLWI are more pronounced in faulty catheter position | ||||||||
Heise et al. [12] | 32 | CVVHF | SVC | SVC, IVC | 183 ± 35 | CO under running CRRT lower than at interrupted CRRT, but clinically negligible But: exclusion of the first measurement after switching CRRT (on/off) reduces these differences | –** | CO measurements after CRRT stopped/started when blood temp. has reached steady state; exclude first measurement after interruption/continuation of CRRT |
Dufour et al. [11] | 69 | CVVHF | SVC (internal jugular vein) | SVC (7 patient), IVC (62 patients) | 250–350 | Independently of the catheter tip position, no significant difference in CI and GEDVI in CVVH performed with high blood pump flow up to 350 mL/min detected when the blood pump was stopped Significant, but clinically not relevant decrease in EVLWI when blood pump was turned off in patients with a femoral dialysis catheter | –** | Blood pump should not be stopped |
Pathil et al. [7] | 30 | SLED | IVC, SVC, separate, not used for hemodialysis | SVC, IVC, | – | During RRT Significant, but “narrow” and therefore “possibly clinically acceptable” decrease in CI Significant decrease in GEDVI Discrete, not statistically significant, but “potentially clinically relevant” reduce in EVLWI | N.d. | Carefully interpret measurements during RRT |
Huber et al. [3] | 32 | SLED | SVC, IVC (different to dialysis cath.) | SVC, IVC | 150 | After connection to RRT No significant changes in CI After disconnection of RRT Significant increase in CI, CPI and GEDVI No significant difference in EVLWI | N.d. | TPTD is accurate despite ongoing RRT |
Own study | 24 | SLED | SVC | SVC, IVC | 180 ± 37 | Pausing of RRT Significantly increased CI and GEDVI Significantly decreased EVLWI and SVRI Independent from dialysis catheter position Independent from blood flow rate No effect, if first measurement within a series was rejected | N.d. | SLED should not be paused for TPTD |