Circuit start during continuous renal replacement therapy in vasopressor-dependent patients: The impact of a slow blood flow protocol

Background and Aims: In vasopressor-dependent patients, we evaluated the impact of a slow blood flow protocol on hypotension when starting continuous renal replacement therapy (CRRT). Methods: Retrospective observational study in tertiary ICU of a slow blood flow protocol at the start of CRRT circuits. Results: 205 circuits in 52 patients were studied. No significant changes in mean arterial pressure (MAP) and norepinephrine dose were found. Only 16 circuit starts in 13 patients were associated with a decrease in MAP >20%. In 23 filters and 11 patients, norepinephrine dose was >50 μg/min at baseline and also did not change significantly. There were no cardiac arrests or ventricular arrhythmias and CRRT was not discontinued because of hypotension. Conclusions: Implementation of a CRRT slow blood flow protocol in vasopressor-dependent patients enabled the initiation of CRRT circuits with limited hemodynamic consequences and no cardiac arrest or ventricular arrhythmia.