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The use of peripheral ultrafiltration for deresuscitation in the critically ill Neil Cody (24169476) PUREID: 629283332 critical care Introduction <br>Fluid deresuscitation is a key phase in fluid management within the critically ill. Although diuretic medication is commonly utilised, metabolic complications can limit their use. Mechanical deresuscitation using ultrafiltration is an efficacious method of deresuscitation but is limited due to the need for specialised large bore central venous access. The purpose of this thesis was to explore the feasibility of using smaller intravenous access devices for mechanical deresuscitation using low flow ultrafiltration. <br><br>Methods <br>Feasibility of flow through the intravascular devices was first assessed using a surrogate patient model in an ex-vivo assessment of flow. Thereafter a small single centre feasibility trial assessing the technical feasibility of low flow ultrafiltration was conducted. Patients were recruited if they were fluid overloaded and a clinician intention to target a negative fluid balance, with a standard multi-lumen central venous catheter in situ. Ultrafiltration was guided by the fluid balance targets set by the treating intensivist. Criteria for feasibility included daily fluid balance within 500ml of a pre-defined clinician target.<br><br>Results <br>Ex-vivo assessment demonstrated that a standard central venous catheter and a peripheral venous catheter allowed adequate flow rates. 18 patients were recruited to the feasibility study and 17 underwent the intervention. The primary outcome of fluid balance within 500mL of target was met on 20 (55.6%) of deresuscitation days. The mean (standard deviation) circuit lifespan was 16.8 (14.7) hours. <br><br>Conclusions<br> This thesis provided evidence for the technical feasibility and safety of low flow ultrafiltration to treat fluid overload using standard central and peripheral venous access. However, circuit loss was common, resulting in variable duration of therapy, limiting widespread application of the technique. While low flow ultrafiltration may be a suitable alternative to the use of diuretics in selected patients, future research should focus on strategies to improve circuit lifespan. 2026-10-01T16:28:34Z Text Thesis 10.17034/32640741.v1 https://figshare.com/articles/thesis/The_use_of_peripheral_ultrafiltration_for_deresuscitation_in_the_critically_ill/32640741 All Rights Reserved