The Continuous Veno-Venous Hemofiltration Learning Curve in the Department of Anesthesiology and Intensive Care I, Târgu Mureş

Abstract

Background and objective. Twenty years ago it was unconceivable to perform renal replacement therapies in intensive care units without the participation of nephrologists. Nowadays, continuous renal replacement is a therapeutic field handled with ease by many intensivists. Our objective was to determine the learning curve slope of the continuous veno-venous hemofiltration (CVVH) in an intensive care department. We quantified experience as the total number of CVVH therapy hours, and efficiency as the mean filter lifespan (MFL).
Method. Retrospective analysis on 77 patients treated with CVVH, (4019 hours of therapy). We studied MFL for each 1000 hours of treatment and we searched for the number of hours where MFL described a statistical improvement (t-Student).
Results. MFL had gradual augmentation for every 1000 hours of therapy, drawing a smooth slope (22.43h; 23.16h; 26.28h). After 1500 h of CVVH (first 30 patients), MFL marked a statistically significant improvement (p = 0.044463), meaning 21.85h for the first 1500 hours, and 26.08h for the next 1500. Conclusions. CVVH learning curve has a smooth slope. To improve MFL as a marker of experience, the intensivist needs at least 1500 hours of practice, or at least 30 patients to be treated.
Key words: continuous hemofiltration, learning curve, critical patient