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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Feb 05

DOI: 10.23736/S0375-9393.18.12474-6


language: English

Acute renal replacement therapy in patients with major extremity injuries

Silvia DE ROSA 1, 2 , Gianluca VILLA 3, Kenji INABA 4, Sara SAMONI 5, Claudio RONCO 1

1 Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy; 2 Department of Anaesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy; 3 Section of Anaesthesiology and Intensive Care, Department of Health Science, University of Florence, Florence, Italy; 4 Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA; 5 Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy


INTRODUCTION: This narrative review will describe treatment options for patients in the ICU with major extremity injury requiring extracorporeal myoglobin removal and contemporaneous support for systemic complications, such as sepsis, systemic inflammation and coagulation disorders.
EVIDENCE ACQUISITION: Peer-reviewed manuscripts indexed in PubMed. A systematic search for articles describing treatment options for patients in the ICU with major extremity injury were included in the analysis. Our group determined by consensus which resources would best inform this review.
EVIDENCE SYNTHESIS: Acute Renal Replacement Therapy (ARRT) for renal support may be needed for patients with major extremity trauma developing AKI. Contemporary advances allow the physician to perform a tailored treatment that closely match patient’s needs. Techniques and equipment for ARRT can be modulated according to the patient’s pathophysiological derangements, maximizing the therapeutic effects and minimizing adverse events.
CONCLUSIONS: Most of the clinical reviews available in the literature on this topic limit their focus to the extracorporeal removal of myoglobin.

KEY WORDS: Acute kidney injury - Renal replacement therapy - Crush syndrome - Degloving injury - Rhabdomyolysis

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Publication History

Article first published online: February 5, 2018
Manuscript accepted: February 2, 2018
Manuscript revised: January 9, 2018
Manuscript received: October 2, 2017

Cite this article as

De Rosa S, Villa G, Inaba K, Samoni S, Ronco C. Acute renal replacement therapy in patients with major extremity injuries. Minerva Anestesiol 2018 Feb 05. DOI: 10.23736/S0375-9393.18.12474-6

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