Home Hemodialysis (HHD) in a Critically Ill Patient With Sepsis

Le résumé fourni par la source

Introduction: HHD has been available as a modality of renal replacement therapy (RRT) since the 1960s for stable patients but not for critically ill patients. This study aims to present an experience in performing HHD in an elderly patient with multiple comorbidities and AKI due to sepsis. Case Description: A 93-year-old man with several chronic diseases (CPOD, atrial fibrillation, dementia, stroke), had sepsis due to cholecystitis, which required percutaneous drainage and broad-spectrum antibiotic therapy (BSAT) for 10 days. After hospital discharge, the patient developed new sepsis due to pneumonia with MODS, and a new BSAT was initiated. The patient presented with gastrointestinal tract symptoms. Oral anticoagulant was discontinued, and total parenteral nutrition was started. All complementary examinations were performed at the patient's home (laboratory tests, ultrasonography, and transthoracic echocardiography). The patient's family refused a hospital regimen. A room in the patient's apartment was structured as an intensive care environment He developed AKI with AKIN 3, RRT was indicated, an HD catheter was implanted, and HHD was initiated. The patient underwent nine sessions of HHD in 2 weeks, with hypervolemia reduction, interruption of the infusion of norepinephrine, improved level of consciousness, conclusion of the antibiotic therapy regimen, and replacement of continuous positive airway pressure with low-flow nasal cannulas. After >3 days, the patient died. Cardiopulmonary resuscitation maneuvers were not performed, as agreed with the family. No conflicts occurred with the patient's family at any time. Discussion: HHD is indicated for stable patients and is possible in palliative care scenario. In our case, HHD was needed for end-of-life symptom management, and the physician board reflected that maintenance dialysis was palliative. All HD sessions (sustained low efficiency dialysis) were maintained full time by a nephrologist and nephrologist nurse in an apartment room structured as an intensive care unit, ensuring patient safety. HHD in critically ill patients is possible in selected cases, especially in a favorable risk-benefit ratio, and attempts to provide a last chance for patient recovery and time for the family to prepare for potential death. To the best of our knowledge, this is the first case of HHD in a critically ill patient in Brazil. HHD should not be used as a dysthanasia therapy.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.