N. Gibney - Academia.edu (original) (raw)

Papers by N. Gibney

Research paper thumbnail of Acetaminophen-Induced Acute Liver Failure Treated with Single-Pass Albumin Dialysis: Report of a Case

The International Journal of Artificial Organs, 2008

Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). ... more Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). When patients fulfill the King's College criteria for acetaminophen-induced ALF (AALF), they have a poor prognosis for survival without liver transplantation. Recent advances in artificial liver support have used albumin as a binding and scavenging molecule in ALF. One method, single-pass albumin dialysis (SPAD), involves dialyzing blood against an albumin-containing solution across a high-flux membrane to remove albumin-bound toxins. Herein, we describe our protocol for SPAD and report its use in a case of AALF as a bridge to native liver recovery. Case A 41-year-old female with no documented history of liver disease presented with acute acetaminophen toxicity and developed hepatic encephalopathy, coagulopathy and lactic acidosis. The patient met King's College criteria for liver transplantation, based on pH and INR, but was deemed not suitable as a candidate due to psychosocial...

Research paper thumbnail of Treatment of hepatic failure following jejunoilestomy by restoration of normal bowel continuity

Irish medical journal, Jan 31, 1979

Research paper thumbnail of Pulmonary amyloid nodule simulating pancoast tumor

Journal of the Canadian Association of Radiologists, 1984

Solitary pulmonary amyloid nodules may be confused with a bronchogenic carcinoma. The diagnosis m... more Solitary pulmonary amyloid nodules may be confused with a bronchogenic carcinoma. The diagnosis may be suspected from the presence of calcification within the nodule and confirmed by trephine or needle aspiration biopsy.

Research paper thumbnail of Endovascular Repair in Traumatic Thoracic Aortic Injuries: Comparison with Open Surgical Repair

Journal of Vascular and Interventional Radiology, 2008

Purpose.-Thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgic... more Purpose.-Thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgical repair (OSR) of traumatic thoracic aortic injury (TTAI). Herein immediate and midterm outcomes of TEVAR are compared with those of OSR. Materials and Methods.-Health records were used to identify patients with TTAI presenting between April 1995 and September 2006. Preoperative patient characteristics, intraoperative variables, procedural costs, and outcomes were recorded. Results.-A total of 103 patients were identified. Twenty-two died before treatment, 19 were treated conservatively, 36 received OSR, and 26 received TEVAR. In the OSR group, time from diagnosis to treatment was 8 hours, the 30-day mortality rate was 11.1%, and all deaths occurred intraoperatively. Thoracic nerve injury occurred in four patients (12.5%), pneumonia in 12 (37.5%), temporary renal failure in one (3%), paraparesis in three (9.4%), and paraplegia in five (15.6%). On follow-up (mean, 61 months), postthoracotomy pleural reaction was seen in three cases (9.4%). In the TEVAR group, time to treatment was 38 hours (P < .01) and the 30-day mortality rate was 7.4% with no intraoperative deaths. Pneumonia was seen in two cases (8.3%) and left arm ischemia was seen in two of 17 patients in whom the left subclavian artery was covered. On midterm follow-up (mean, 17 months), there were no graft failures or repeat aortic interventions. Costs of each procedure were initially comparable, but follow-up expenses with TEVAR were $1,284 (Canadian) greater per year. Conclusions.-TEVAR of TTAI is associated with lower perioperative mortality and morbidity rates than OSR, with no significant graft-related complications on midterm follow-up. The study data support the continued use of TEVAR in this context (Tables 1, 3, and 4). : Treatment of traumatic thoracic aortic injuries (TTAI) has traditionally consisted of open surgical repair (OSR), but this approach is associated with

Research paper thumbnail of Continuous arteriovenous hemodialysis: An alternative therapy for acute, renal failure associated with critical illness

Journal of Critical Care, 1990

infusion resulted in significant improvements in systemic vascular resistance index, systolic, di... more infusion resulted in significant improvements in systemic vascular resistance index, systolic, diastolic and mean arterial pressures and urine flow. Coronary perfusion pressure increased more than triple index (systolic arteriai pressure x wedge pressure x heart rate). Despite not reaching significant values, there was a tendency in most patients to decrease oxygen delivery and oxygen consumption. 3 of 6 patients sustained a nonsignificant rise in lactates. 2 patients died within 72 hours. Despite good urine output response and improvement in blood pressure, an oxygen debt may be aggravated. This underlines the importance of careful titration of NE infusion.

Research paper thumbnail of One-year outcome of elderly and young patients admitted to intensive care units

Critical Care Medicine, 1993

Research paper thumbnail of Thermodilution Cardiac Output Measurements To the Editor

Critical Care Medicine, 1984

Research paper thumbnail of Could Susceptibility to Low Hematocrit Interference Have Compromised the Results of the NICE-SUGAR Trial?

Research paper thumbnail of Comparison of Work of Breathing on High Gas Flow and Demand Valve Continuous Positive Airway Pressure Systems

Chest, 1982

v-. oa-liDe computer ualyBis, abe work of breatbfaa (WOB) was meaoared iD tea aorm81 Jabjed!l bre... more v-. oa-liDe computer ualyBis, abe work of breatbfaa (WOB) was meaoared iD tea aorm81 Jabjed!l breatbfaa CluoaP foar eoatinaous positive .UW.y preMUte (CPAP) drcaltl. Two systems (Emenoa veatllator) and MGH eiMdc: loaded re~erVolr)Jill (ELRB) were bJp eoatlaaous low systems and two (Purltaa-BenneU MA-2 and Bo111111 Bear venCDators) were demand valve clr

Research paper thumbnail of Canine Tracheal Mucus Transport of Particulate Pollutants: Comparison of Radiolabeled Com Pollen, Ragweed Pollen, Asbestos, Silica, and Talc to Dowex® Anion Exchange Particles

Archives of Environmental Health: An International Journal, 1980

Canine tracheal mucous transport rates of each of two organic (corn and ragweed pollen), and thre... more Canine tracheal mucous transport rates of each of two organic (corn and ragweed pollen), and three inorganic (chrysotile asbestos fibers, silica, and talc), 99mTc labeled pollutants were simultaneously measured against those of 125I labeled Dowex anion exchange resin particles in healthy animals. The method of labeling of the pollutants with 99mTc is described. With the exception of ragweed pollen, which moved 15% faster than the reference marker (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.02), we found no difference in the transport rates of these particulate pollutants and the reference marker. We conclude that the particulate pollutants studied are handled by the mucociliary system in a similar fashion, and that the transport rates of Dowex particles represent valid measurements of the transport rates of these pollutants.

Research paper thumbnail of Regional citrate anticoagulation in continuous venovenous hemodiafiltration

American Journal of Kidney Diseases, 2000

Research paper thumbnail of Slurry lung": a report of three cases

Research paper thumbnail of Recurrent symptomatic pulmonary embolism caused by an infected Pudenz cerebrospinal fluid shunt device

Research paper thumbnail of Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Critical Care, 2016

This article reports the conclusions of the second part of a consensus expert conference on the n... more This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis.

Research paper thumbnail of Paradoxical vocal cord motion asthma

Research paper thumbnail of Non-invasive arterial systolic blood pressure measurement in lower limb ischaemia

Irish Journal of Medical Science, 1978

SummaryObjective assessment of ischaemic limbs by non invasive blood pressure measurements has be... more SummaryObjective assessment of ischaemic limbs by non invasive blood pressure measurements has been evaluated. The uses and limitations of these methods are discussed. Segmental pressure measurements and pressure indices would appear to be useful adjuncts to clinical examination in patients with peripheral vascular disease.

Research paper thumbnail of Use of the subcutaneous route of administration of morphine in the intensive care unit

Journal of pain and …, 1991

Subcutaneous morphine was administered to 13 consecutive patients admitted to an intensive care u... more Subcutaneous morphine was administered to 13 consecutive patients admitted to an intensive care unit. Intermittent injections via a butterfly needle and via continuous infusion were used in 11 and 2 cases, respectively. The mean daily dose of morphine and ...

Research paper thumbnail of Human rabies encephalitis following bat exposure: failure of therapeutic coma

Canadian Medical …, 2008

The case: A healthy 73-year-old man had pain in his left shoulder. He presented to a regional hos... more The case: A healthy 73-year-old man had pain in his left shoulder. He presented to a regional hospital 1 week later with fever, dysphagia, muscle spasms and progressive generalized weakness. His neurologic status deteriorated, which prompted transfer to a tertiary care hospital. Upon the patient's arrival at the tertiary care hospital, our initial evaluation showed irritability, lethargy and hypersalivation. After 48 hours, the patient exhibited multifocal myoclonus and decorticate posturing. Intubation and mechanical ventilation were performed with fluid resuscitation and therapy with vasopressors, corticosteroids and broad-spectrum antibiotics. A computed tomography scan of his brain was unremarkable. An electroencephalogram showed diffuse abnormalities consistent with metabolic encephalopathy. We investigated potential rabies exposure, and his family confirmed that he had sustained a bat bite on his left shoulder 6 months previously but had not sought treatment. We performed a nuchal skin biopsy and obtained saliva and serum samples for rabies virologic and serologic testing. Direct fluorescent antibody staining indicated that the skin biopsy contained rabies virus antigen, and reverse-transcriptase polymerase chain reaction indicated that both the skin and saliva samples contained the rabies virus. Diagnostic tests available for suspected rabies cases in Canada are described in Box 1. The patient received an intramuscular injection of 1200 IU of human rabies immune globulin. We started the Milwaukee Protocol 15 days after symptom onset (3 days after diagnosis). The Protocol consisted of inducing a therapeutic coma (infusions of ketamine, midazolam and propofol titrated to burst-suppression pattern on the electroencephalogram) and antiviral therapy (ribavirin, aman

Research paper thumbnail of Acute Dialysis Quality Initiative Fifth International Consensus Conference

Although an adequate intravascular volume is essential for tissue perfusion and oxygenation, exce... more Although an adequate intravascular volume is essential for tissue perfusion and oxygenation, excessive intravascular volume promotes pulmonary edema which itself impairs gas exchange. Thus, one balances euvolemia between hypovolemic shock and ...

Research paper thumbnail of Volume management by renal replacement therapy in acute kidney injury

Management of fluid balance is one of the basic but vital tasks in the care of critically ill pat... more Management of fluid balance is one of the basic but vital tasks in the care of critically ill patients. Hypovolemia results in a decrease in cardiac output and tissue perfusion and may lead to progressive multiple organ dysfunction, including the development of acute renal injury (AKI). However, in an effort to reverse pre-renal oliguria, it is not uncommon for patients with established oliguric acute renal failure, particularly when associated with sepsis, to receive excessive fluid resuscitation, leading to fluid overload. In patients with established oliguria, renal replacement therapy may be required to treat hypervolemia. Safe prescription of fluid loss during RRT requires intimate knowledge of the patient's underlying condition, understanding of the process of ultrafiltration and close monitoring of the patient's cardiovascular response to fluid removal. To preserve tissue perfusion in patients with AKI, it is important that RRT be prescribed in a way that optimizes fluid balance by removing fluid without compromising the effective circulating fluid volume. In patients who are clinically fluid overloaded, it is equally important that the amount of fluid removed be as exact as possible. Fluid balance errors can occur as a result of inappropriate prescription, operator error or machine error. Some CRRT machines have potential for significant fluid errors if alarms can be overridden. Threshold values for fluid balance error have been developed which can be used to predict the severity of harm. It is important that RRT education programs emphasize the risk associated with fluid balance errors and with overriding machine alarms.

Research paper thumbnail of Acetaminophen-Induced Acute Liver Failure Treated with Single-Pass Albumin Dialysis: Report of a Case

The International Journal of Artificial Organs, 2008

Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). ... more Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). When patients fulfill the King's College criteria for acetaminophen-induced ALF (AALF), they have a poor prognosis for survival without liver transplantation. Recent advances in artificial liver support have used albumin as a binding and scavenging molecule in ALF. One method, single-pass albumin dialysis (SPAD), involves dialyzing blood against an albumin-containing solution across a high-flux membrane to remove albumin-bound toxins. Herein, we describe our protocol for SPAD and report its use in a case of AALF as a bridge to native liver recovery. Case A 41-year-old female with no documented history of liver disease presented with acute acetaminophen toxicity and developed hepatic encephalopathy, coagulopathy and lactic acidosis. The patient met King's College criteria for liver transplantation, based on pH and INR, but was deemed not suitable as a candidate due to psychosocial...

Research paper thumbnail of Treatment of hepatic failure following jejunoilestomy by restoration of normal bowel continuity

Irish medical journal, Jan 31, 1979

Research paper thumbnail of Pulmonary amyloid nodule simulating pancoast tumor

Journal of the Canadian Association of Radiologists, 1984

Solitary pulmonary amyloid nodules may be confused with a bronchogenic carcinoma. The diagnosis m... more Solitary pulmonary amyloid nodules may be confused with a bronchogenic carcinoma. The diagnosis may be suspected from the presence of calcification within the nodule and confirmed by trephine or needle aspiration biopsy.

Research paper thumbnail of Endovascular Repair in Traumatic Thoracic Aortic Injuries: Comparison with Open Surgical Repair

Journal of Vascular and Interventional Radiology, 2008

Purpose.-Thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgic... more Purpose.-Thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgical repair (OSR) of traumatic thoracic aortic injury (TTAI). Herein immediate and midterm outcomes of TEVAR are compared with those of OSR. Materials and Methods.-Health records were used to identify patients with TTAI presenting between April 1995 and September 2006. Preoperative patient characteristics, intraoperative variables, procedural costs, and outcomes were recorded. Results.-A total of 103 patients were identified. Twenty-two died before treatment, 19 were treated conservatively, 36 received OSR, and 26 received TEVAR. In the OSR group, time from diagnosis to treatment was 8 hours, the 30-day mortality rate was 11.1%, and all deaths occurred intraoperatively. Thoracic nerve injury occurred in four patients (12.5%), pneumonia in 12 (37.5%), temporary renal failure in one (3%), paraparesis in three (9.4%), and paraplegia in five (15.6%). On follow-up (mean, 61 months), postthoracotomy pleural reaction was seen in three cases (9.4%). In the TEVAR group, time to treatment was 38 hours (P < .01) and the 30-day mortality rate was 7.4% with no intraoperative deaths. Pneumonia was seen in two cases (8.3%) and left arm ischemia was seen in two of 17 patients in whom the left subclavian artery was covered. On midterm follow-up (mean, 17 months), there were no graft failures or repeat aortic interventions. Costs of each procedure were initially comparable, but follow-up expenses with TEVAR were $1,284 (Canadian) greater per year. Conclusions.-TEVAR of TTAI is associated with lower perioperative mortality and morbidity rates than OSR, with no significant graft-related complications on midterm follow-up. The study data support the continued use of TEVAR in this context (Tables 1, 3, and 4). : Treatment of traumatic thoracic aortic injuries (TTAI) has traditionally consisted of open surgical repair (OSR), but this approach is associated with

Research paper thumbnail of Continuous arteriovenous hemodialysis: An alternative therapy for acute, renal failure associated with critical illness

Journal of Critical Care, 1990

infusion resulted in significant improvements in systemic vascular resistance index, systolic, di... more infusion resulted in significant improvements in systemic vascular resistance index, systolic, diastolic and mean arterial pressures and urine flow. Coronary perfusion pressure increased more than triple index (systolic arteriai pressure x wedge pressure x heart rate). Despite not reaching significant values, there was a tendency in most patients to decrease oxygen delivery and oxygen consumption. 3 of 6 patients sustained a nonsignificant rise in lactates. 2 patients died within 72 hours. Despite good urine output response and improvement in blood pressure, an oxygen debt may be aggravated. This underlines the importance of careful titration of NE infusion.

Research paper thumbnail of One-year outcome of elderly and young patients admitted to intensive care units

Critical Care Medicine, 1993

Research paper thumbnail of Thermodilution Cardiac Output Measurements To the Editor

Critical Care Medicine, 1984

Research paper thumbnail of Could Susceptibility to Low Hematocrit Interference Have Compromised the Results of the NICE-SUGAR Trial?

Research paper thumbnail of Comparison of Work of Breathing on High Gas Flow and Demand Valve Continuous Positive Airway Pressure Systems

Chest, 1982

v-. oa-liDe computer ualyBis, abe work of breatbfaa (WOB) was meaoared iD tea aorm81 Jabjed!l bre... more v-. oa-liDe computer ualyBis, abe work of breatbfaa (WOB) was meaoared iD tea aorm81 Jabjed!l breatbfaa CluoaP foar eoatinaous positive .UW.y preMUte (CPAP) drcaltl. Two systems (Emenoa veatllator) and MGH eiMdc: loaded re~erVolr)Jill (ELRB) were bJp eoatlaaous low systems and two (Purltaa-BenneU MA-2 and Bo111111 Bear venCDators) were demand valve clr

Research paper thumbnail of Canine Tracheal Mucus Transport of Particulate Pollutants: Comparison of Radiolabeled Com Pollen, Ragweed Pollen, Asbestos, Silica, and Talc to Dowex® Anion Exchange Particles

Archives of Environmental Health: An International Journal, 1980

Canine tracheal mucous transport rates of each of two organic (corn and ragweed pollen), and thre... more Canine tracheal mucous transport rates of each of two organic (corn and ragweed pollen), and three inorganic (chrysotile asbestos fibers, silica, and talc), 99mTc labeled pollutants were simultaneously measured against those of 125I labeled Dowex anion exchange resin particles in healthy animals. The method of labeling of the pollutants with 99mTc is described. With the exception of ragweed pollen, which moved 15% faster than the reference marker (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.02), we found no difference in the transport rates of these particulate pollutants and the reference marker. We conclude that the particulate pollutants studied are handled by the mucociliary system in a similar fashion, and that the transport rates of Dowex particles represent valid measurements of the transport rates of these pollutants.

Research paper thumbnail of Regional citrate anticoagulation in continuous venovenous hemodiafiltration

American Journal of Kidney Diseases, 2000

Research paper thumbnail of Slurry lung": a report of three cases

Research paper thumbnail of Recurrent symptomatic pulmonary embolism caused by an infected Pudenz cerebrospinal fluid shunt device

Research paper thumbnail of Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Critical Care, 2016

This article reports the conclusions of the second part of a consensus expert conference on the n... more This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis.

Research paper thumbnail of Paradoxical vocal cord motion asthma

Research paper thumbnail of Non-invasive arterial systolic blood pressure measurement in lower limb ischaemia

Irish Journal of Medical Science, 1978

SummaryObjective assessment of ischaemic limbs by non invasive blood pressure measurements has be... more SummaryObjective assessment of ischaemic limbs by non invasive blood pressure measurements has been evaluated. The uses and limitations of these methods are discussed. Segmental pressure measurements and pressure indices would appear to be useful adjuncts to clinical examination in patients with peripheral vascular disease.

Research paper thumbnail of Use of the subcutaneous route of administration of morphine in the intensive care unit

Journal of pain and …, 1991

Subcutaneous morphine was administered to 13 consecutive patients admitted to an intensive care u... more Subcutaneous morphine was administered to 13 consecutive patients admitted to an intensive care unit. Intermittent injections via a butterfly needle and via continuous infusion were used in 11 and 2 cases, respectively. The mean daily dose of morphine and ...

Research paper thumbnail of Human rabies encephalitis following bat exposure: failure of therapeutic coma

Canadian Medical …, 2008

The case: A healthy 73-year-old man had pain in his left shoulder. He presented to a regional hos... more The case: A healthy 73-year-old man had pain in his left shoulder. He presented to a regional hospital 1 week later with fever, dysphagia, muscle spasms and progressive generalized weakness. His neurologic status deteriorated, which prompted transfer to a tertiary care hospital. Upon the patient's arrival at the tertiary care hospital, our initial evaluation showed irritability, lethargy and hypersalivation. After 48 hours, the patient exhibited multifocal myoclonus and decorticate posturing. Intubation and mechanical ventilation were performed with fluid resuscitation and therapy with vasopressors, corticosteroids and broad-spectrum antibiotics. A computed tomography scan of his brain was unremarkable. An electroencephalogram showed diffuse abnormalities consistent with metabolic encephalopathy. We investigated potential rabies exposure, and his family confirmed that he had sustained a bat bite on his left shoulder 6 months previously but had not sought treatment. We performed a nuchal skin biopsy and obtained saliva and serum samples for rabies virologic and serologic testing. Direct fluorescent antibody staining indicated that the skin biopsy contained rabies virus antigen, and reverse-transcriptase polymerase chain reaction indicated that both the skin and saliva samples contained the rabies virus. Diagnostic tests available for suspected rabies cases in Canada are described in Box 1. The patient received an intramuscular injection of 1200 IU of human rabies immune globulin. We started the Milwaukee Protocol 15 days after symptom onset (3 days after diagnosis). The Protocol consisted of inducing a therapeutic coma (infusions of ketamine, midazolam and propofol titrated to burst-suppression pattern on the electroencephalogram) and antiviral therapy (ribavirin, aman

Research paper thumbnail of Acute Dialysis Quality Initiative Fifth International Consensus Conference

Although an adequate intravascular volume is essential for tissue perfusion and oxygenation, exce... more Although an adequate intravascular volume is essential for tissue perfusion and oxygenation, excessive intravascular volume promotes pulmonary edema which itself impairs gas exchange. Thus, one balances euvolemia between hypovolemic shock and ...

Research paper thumbnail of Volume management by renal replacement therapy in acute kidney injury

Management of fluid balance is one of the basic but vital tasks in the care of critically ill pat... more Management of fluid balance is one of the basic but vital tasks in the care of critically ill patients. Hypovolemia results in a decrease in cardiac output and tissue perfusion and may lead to progressive multiple organ dysfunction, including the development of acute renal injury (AKI). However, in an effort to reverse pre-renal oliguria, it is not uncommon for patients with established oliguric acute renal failure, particularly when associated with sepsis, to receive excessive fluid resuscitation, leading to fluid overload. In patients with established oliguria, renal replacement therapy may be required to treat hypervolemia. Safe prescription of fluid loss during RRT requires intimate knowledge of the patient's underlying condition, understanding of the process of ultrafiltration and close monitoring of the patient's cardiovascular response to fluid removal. To preserve tissue perfusion in patients with AKI, it is important that RRT be prescribed in a way that optimizes fluid balance by removing fluid without compromising the effective circulating fluid volume. In patients who are clinically fluid overloaded, it is equally important that the amount of fluid removed be as exact as possible. Fluid balance errors can occur as a result of inappropriate prescription, operator error or machine error. Some CRRT machines have potential for significant fluid errors if alarms can be overridden. Threshold values for fluid balance error have been developed which can be used to predict the severity of harm. It is important that RRT education programs emphasize the risk associated with fluid balance errors and with overriding machine alarms.