Undetected blood flow reductions occur during continuous veno-venous haemofiltration. Such reductions are frequent, and when sufficiently severe appear to be correlated with filter life more strongly than the blood coagulation variables typically used to monitor adequacy of anticoagulation and promote filter longevity.

CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH.

Objectives Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. Methods Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. Results A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p<0.01). Mean arterial pressure in the EDDf group was lower at two hours after starting treatment (76 mmHg vs. 94 mmHg) in the CVVH group; p= 0.031. There was no significant difference between groups for heart rate, CVP and noradrenaline dose at all time intervals measured. Conclusions Adequate prescribed fluid removal was achieved with both techniques. However, as expected, fluid was removed at a faster rate during EDDf. This was initially associated with a lower blood pressure than during CVVH where blood pressure increased.

Blood flow during CRRT can be monitored by an ultrasound Doppler probe and displayed graphically. Preliminary data using this technique suggest potentially serious and undetected problems with blood flow during routine CRRT.

Aims and objectives.  The main objective of this project was to investigate the likelihood of creating an easily understood rating system for all aged care homes. A secondary objective was to canvas the feasibility of alternative systems that could better inform aged care consumers. Background.  Standards rating systems are used internationally to enable comparisons in healthcare. In Australia, the performance of numerous services and products are measured according to the star system of ratings, yet despite their widespread use, star ratings remain absent from the healthcare industry. Methods.  A National Consultative Group (NCG) consisting of key stakeholder representatives was consulted, and a literature review performed on existing standards (or 'star') rating systems. Telephone interviews were conducted with representatives from aged care homes, as well as consumers. Results.  A standards rating system for aged care homes was not found to be feasible in the current climate. However, an alternative system that emphasises empowering aged care consumers, such as one that allows consumers to search for an aged care home using their own criteria of preference, was considered more feasible. Conclusion.  The need for information to assist consumer choice - limited as it may be - is real. Ways of providing more consumer friendly, useful information need to be further explored and developed. Recommendations are made for future work in this area.