Gestion pratique de l'épuration extrarénale continue au quotidien Practical daily management of extrarenal continuous removal

Summary The incorporation of findings based on two recently published studies into dailyclinical practice in continuous venovenous haemofiltration (CVVH) in 2008 can now be deemedto be urgent. These studies highlight the crucial role of adequate dosage of CVVH, whereby adose of 35mL/kg per hour was associated, in critically ill patients in renal failure, with dra-matic improvement and survival of nearly 20%. These two studies provide the best currentlyavailable evidence, though the results of other confirmatory (or not as the case may be) studiesstill ongoing are awaited. In a world increasingly guided by Evidence Based Medicine, two levelI studies will lead to a Grade A recommendation, which should therefore be applied by everyintensivist instigating continuous haemofiltration, while awaiting the results of the ongoing stu-dies.Nevertheless, the implementation process in the daily practice of intensive care medicinewill have to overcome a number of potential difficulties. These encompass items as blood flowrequirements, vascular access problems, pre- and postdilution policy, type of membranes usedas well as restitution fluid and the possible need for associated dialysis, to name the mostimportant ones. This paper will describe in detail, from a strictly practical basis, how to imple-ment these changes in routine daily practice at the ICU bedside. These implementations willobviously necessitate a collaborative network between medical staff members and the entirenursing staff.© 2008 Societe de reanimation de langue franc¸aise. Publie par Elsevier Masson SAS. Tous droitsreserves.