WHO SHOULD MANAGE CRRT IN THE ICU - THE INTENSIVISTS VIEWPOINT

The arrival of continuous renal replacement therapy (CRRT) has given t he intensivist and the intensive care nurse the opportunity to treat a cute renal failure (ARF) independently by giving them the necessary te chnology and taking CRRT away from absolute nephrological control, Thi s structural shift has created a controversy between those countries w here control of CRRT has completely shifted to the intensivist and tho se countries where nephrological input is still dominant, The argument in favor of intensivist-driven CRRT rests upon several observations, including the fact that therapy is continuous, as is the presence of t he intensivist in the intensive care unit (ICU), Critically ill patien ts require rapid changes in treatment that are best directed by physic ians who are at the bedside all the time, CRRT must be seen within the totality of patient care, and the intensivist can see the larger pict ure more accurately, Intensivists are successfully performing more and more procedures that were previously seen as part of other specialtie s and, last but not least, ''closed'' models of ICU care appear to wor k best, Australian intensivists have taken up CRRT from the start and now control it, Patient outcomes under such a system, as reported here , are above average, and confirm the effectiveness of such an approach . (C) 1997 by the National Kidney Foundation, Inc.