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Acute renal failure occurs in 5.5% to 6.0% of patients admitted to the intensive care unit (ICU), with almost three-fourths of these patients requiring the institution of continuous renal replacement therapy (CRRT) via temporary double-lumen vascular catheters. These patients are usually restricted to bed to avoid catheter dislodgement, infection, and thrombosis. One study showed that early mobilization was found to be safe and associated with no adverse events, and an increase in filter life in the group with femoral catheter. Another one showed In-hospital mortality was lowest for patients who ambulated (17.95%) and highest for patients who received no therapy (73.53%). Early physical therapy is crucial in the management of critically ill patients, and it is associated with decreased syndrome pos UCI stay, frailty, and hospital length of stay.
Patients are chosen to walk by the ICU physiotherapists daily on week-days. CRRT was generally delivered via continuous veno-venous hemodiafiltration (CVVHDF) using Prismaflex at dialysate rate of 20 ml/kg/h, a replacement fluid rate of 15 ml/kg/h (delivered after the filter) and an effluent fluid removal rate of 50 to 100 ml/h. Exclusion criteria: hemodynamics alteration, vasopressor use, fever, agitation, coma, heart rate < 40 bpm and >130 bpm; systolic blood pressure (SBP) < 90mmHg and >180mmHg; mean arterial pressure <60mmHg and >110mmHg. respiratory rate < 5 rpm and >40 rpm; and peripheral oxygen saturation >88%; intracranial hypertension; Inclusion criteria: to be able to understand and carry out commands appropriately, and open eyes to verbal stimulation, adults (age ≥ 18 years) admitted to a clinical or surgical ICU for at least 72 hours, breathing spontaneously; no intracranial hypertension, hemodynamic stability (defined as SBP > 90mmHg and < 170mmHg) and respiratory stability (preferably with oxygen saturation - SpO2 > 90%, under inspired oxygen fraction ≤ 60% and respiratory rate < 25 rpm). The intervention group was formed by a physiotherapist, nurse and two health professional. We apply this procedure to selected patients with a consent term but we chose only 10 patients to show, those who were filmed.
During the care, no adverse events occurred at the time of ambulation, such as: catheter dislodgement, machine instability, flow interruption. There was no hemodynamic changes. There were no deaths related to the hemodialysis patient's ambulation.
Maintenance of the filter circuit is important, as premature disconnection results in loss of blood, increased nursing workload and increased costs. Filter life is also an important indicator of CRRT efficacy. The specific effects of mobilization on the vascular catheter, circuit pressures, fluid dynamics and blood flow in patients receiving CRRT via dual-lumen femoral vascular catheters are uncertain. We decided to share our experience while we are working hard to improve our data base with approval by research clinical center. Until now it was a physiotherapy approach. We hope to motivate other groups to start this initiative. Mobilization during renal replacement therapy through a vascular catheter in critically ill patients is safe and can increase the useful life of the filter. The success depends on a multidisciplinary approach.