Continuous arteriovenous haemofiltration in children (original) (raw)
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Treatment of acute renal failure in an infant using continuous arteriovenous hemofiltration
The Journal of Pediatrics, 1985
premature infant remains a problem. For fluid-overloaded patients in whom conservative management (i.e., fluid restriction, diuretics) fails, the choice has been either peritoneal dialysis or hemodialysis. Although hemodialysis in small infants has been successfully performed, ~ peritoneal dialysis is technically simpler, does not require highly trained personnel, and is the procedure of choice in most neonatal ICUs?-3 Peritoneal dialysis, however, entails the risks of catheter placement; furthermore, intra-abdominal disease or a coagulopathy may render this procedure dangerous or impossible. Hemodialysis is a hazardous and arduous technique in the neonate, requiring substantial extracorporeal blood volume and flow that can cause rapid osmotic shifts, with the concomitant risks of hypotension and dysequilibrium. 1,4, 5 We report the application of continuous arteriovenous hemofiltration for the treatment of renal failure with fluid overload. This modality does not require highly trained personnel or special equipment. A short extracorporeal circuit allows the gradual removal of water and solutes. The patient's own systemic blood pressure provides the driving force for blood flow through a hollow-fiber hemofilter? CASE REPORT This 1300 gm infant girl was born after 32 weeks gestation to a 28-year-old woman who had a history of five spontaneous first
Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration
Journal of Critical Care, 1987
Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration. The treatment of acute renal failure (ARF) in the newborn with hemo-or peritoneal dialysis is technically difficult and may even be contraindicated. As in the adult, continuous arteria-venous hemofiltration (CA VH) may be an alternative therapy. We used CA VH in the treatment of four newborns with ARF of different etiology. Two brachial, one femoral and one umbilical arteries were cannulated as arterial access, while three jugular and one umbilical veins were used as venous return. An Amicon 0.005 m 2 Polysulphon Hollow Fiber hemofilter was connected to the patient with shortened pediatric hemodialysis lines. Total blood volume of the extracorporeal circuit was 15 to 22 ml. Before starting the procedure, an initial bolus of heparin was administered to the patient (100 i.u./kg body wt) and a successive continuous heparin administration was provided during the treatment at the rate of 5 to 7 i. u.lkg/hr. Hyperalimentation and/or buffer solutions were used as replacement fluids and were administered according to the patient's fluid balance. Mean data in the four patients are summarized as follows. The age of the patients ranged from two to 12 days, while the average body weight was about 3 kg. The ultrafiltration rate during the treatment averaged 0.9 mlImin with a plasma flow ranging from 9.8 to 19.6 mllmin. The treatment duration varied from 30 to 86 hrs. The treatment was well tolerated (patients 1 and 2 recovered, and patients 3 and 4 died due to complications unrelated to the treatment). Arterial pressure remained stable during the procedure. Metabolic acidosis, when present, was corrected by increasing the amount of buffer administered. BUN was maintained below 60 mg/dl in three patients. In one patient catabolism was severe and CA VH was discontinued due to increasing levels of BUN. In conclusion, CAVH appears to be a safe alternative treatment for newborns with ARF and/or fluid and electrolyte imbalance. Severe catabolism may limit its application. When acute renal failure (ARF) occurs in newborns, it is mainly due to renal hypoperfusion secondary to intra-or post-operative hypotension or to perinatal asphyxia-hypoxic shock like conditions [1]. We generally treat these patients using peritoneal dialysis. In fact hemodialysis may be dangerous or difficult to carry out in very small patients. However, when ARF follows an episode of abdominal surgery, peritoneal dialysis may be precluded or contraindicated and an alternative treatment is required. The same problem may arise when severe cardiovascular instability or hypotension are
A review of venovenous haemofiltration in seriously ill infants
Journal of Paediatrics and Child Health, 1994
Between April 1989 and October 1991, 13 severely ill infants, median age 13 days (range 1-180 days), median weight 3.5 kg (range 2.5-4.8 kg). received continuous venovenous haemofiltration (CWH) for a median duration of 39 h (range 5-234 h). Filtration was performed through a double lumen catheter inserted into a central vein. The indications for filtration included acute renal failure (8), fluid overload (5), inborn errors of metabolism (3) and sepsis (1). Some infants had more than one indication. The median Paediatric Risk of Mortality (PRISM) score on the day of admission to the intensive care unit was 27 (range 8-42). No change in the level of respiratory support was required following the commencement of CVVH. Serum electrolyte concentrations and plasma osmolality remained normal throughout. Serum creatinine fell from a mean of 0.1 1 mmol/L (95% CI 0.058-0.168) to 0.07 mmol/L (CI 0.034-0.112). Urea fell from a mean of 9.5 mmolIL (CI 4.4-14.6) to 6.5 mmol/L(CI 2.7-10.3). Platelet counts fell by 40-50%from a mean of 126x 106/mm3 (CI 72-180) to 69x 106/mm3(CI 36-103) 18 h following commencement of filtration but no bleeding was encountered. The main complication was a thrombosis of the superior and inferior vena cava in one infant. Four infants survived to be discharged from intensive care. Continuous venovenous haemofiltration, with its inherent advantages over arteriovenous haemofiltration, is feasible in small infants using standard paediatric equipment.
Hemofiltration in Children with Renal Failure
Pediatric Clinics of North America, 1987
Hemofiltration is a relatively new and interesting form of treatment for patients with end-stage renal disease. Technological advances and improved monitoring devices have simplified hemofiltration and made it available to children. We have used hemofiltration in children with endstage renal disease as an alternative to hemodialysis since 1984. Our experience shows that hemofiltration is better tolerated by children and that solute removal is not significantly different from hemodialysis, despite shorter treatment times. The term hemofiltration defines-an extracorporeal process in which uremic whole blood is cleansed by a technique based solely on the principle of convective solute transport. During this procedure, an ultrafiltrate of the plasma is created by hydrostatic pressure exerted across a highly permeable membrane. Simultaneously, the blood volume is replaced up to the desired amount by a modified Ringer's lactate solution. Although various terms have been used to describe this procedure (diafiltration, he modiafiltration , hemoultrafiltration), hemofiltration was agreed on as the best term by the workers in this field at a meeting in Gstaad (February 1977) and will be used throughout this article. 8 HEMOFILTRATION: BEGINNINGS Ultrafiltration of blood dates back to the late 1800s, when Sanarelli 5 designed it as a test system to evaluate the middle molecule hypothesis.
Literature Review of the Efficacy of High-Volume Hemofiltration in Critically Ill Pediatric Patients
Blood Purification
Background: Pediatric sepsis is a significant public health issue. This condition is exacerbated by rising serum creatinine and inflammatory cytokines that lead to deleterious effects upon the body. The current standard of care involves the use of continuous kidney replacement therapy to remove harmful cytokines until the body returns to homeostasis. In order to promote faster clearance and reduced stay in the ICU, high-volume hemofiltration (HVHF) has shown promise. However, there is a paucity of studies to fully elucidate its benefits. Methods: A literature search was done using PubMed/ MEDLINE and Embase. The literature was reviewed by two independent reviewers, who independently assessed the quality of randomized controlled trials by using the Cochrane risk of bias tool for RCTs and Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized controlled trials. Data were combined from studies with a similar design. Results: The primary endpoint of all-cause mortality ...
Renal Failure, 2014
Introduction: As intensive care units (ICU) have improved, presence of multiple-organ dysfunctions in majority of patients with acute renal failure (ARF) has become clearer. To facilitate multi-organ support, continuous renal replacement therapy (CRRT) techniques have been developed. This study is the one that reports the experience on children including newborns receiving CRRT monitored in ICU. Materials and Methods: The study was performed retrospectively in children who had Continuous Veno-Venous Hemodiafiltration (CVVHDF) as a CRRT modality in ICU. Clinical data, primary cause, consultation time, duration and initiation time of CVVHDF were recorded. Patients were classified as cardiac and non-cardiac in respect to primary dysfunction. Stage of renal failure was evaluated according to pRIFLE criteria. Outcome was identified as primary and secondary. Primary outcome was accepted as the composite correction of uremia and metabolic parameters, and regression of fluid overload, while secondary outcomes were assessed as improvement of hemodynamic instability and survival. Results: A total of 36 patients' files were scanned. There were 10 cases in cardiac group and 26 cases in non-cardiac group. There were statistically better differences between primary and secondary outcome rates of cardiac cases. Although there was no difference between cardiac and non-cardiac cases in terms of primary outcome, secondary outcome was statistically significant. Timing of consultation and CVVHDF was not found to have an effect on the outcome. Conclusion: Our results indicated that CVVHDF treatment was successful even in cardiac patients with high mortality and in patients at their later stage of ARF.
Pediatric Critical Care Medicine, 2017
Objectives: Renal replacement therapy may be required for acute kidney injury treatment in neonates with complex cardiac conditions. Continuous veno-venous hemofiltration is applied safely in this population but no published recommendations for dose prescription in neonates currently exist. The aim of our study was to evaluate the effects of a relatively small dialysis dose on critically ill neonates. Design: Retrospective analysis of clinical charts. Setting: Pediatric Cardiac ICU. Patients: Ten critically ill neonates with severe acute kidney injury were analyzed. The primary indication for continuous veno-venous hemofiltration initiation was severe fluid overload with oligoanuria. Interventions: None. Measurements and Main Results: The median (range) age and weight were 3 days (1-12 d) and 2.6 kg (2.1-4.2 kg), respectively, whereas the median continuous veno-venous hemofiltration duration was 17 days (3-63 d). Median prescribed blood flow rate, replacement fluid rate, and net ultrafiltration rate were 12 mL/min (9-50 mL/min), 100 mL/hr (40-200 mL/hr), and 20 mL/hr (5-45 mL/hr), respectively. The median effluent-based continuous veno-venous hemofiltration dose was 35 mL/kg/hr (11-66 mL/kg/ hr), whereas the median delivered daily Kt/V per session (24 hr) was 0.5 (0.01-1.8). However, for treatment sessions lasting less than or equal to 12 versus greater than or equal to 12 hours per session, the median prescribed effluent dose was 41 (11-66) and 32 (17-60) mL/kg/hr, respectively (p = 0.06), whereas the delivered creatinine daily Kt/V values were 0.3 (0.01-0.9) and 0.9 (0.5-1.8), respectively (p < 0.0001). An inverse correlation was found between delivered daily Kt/V and the blood concentration differences of both creatinine (r =-0.3; p = 0.0093) and urea (r =-0.3; p = 0.0028) measured at the end and the beginning of a 24-hour treatment. The decrease of creatinine concentration was significantly greater during 24-hour treatment sessions with a delivered daily Kt/V greater than 0.9 than during those with daily Kt/V less than 0.9. Conclusions: Based on these findings, we propose on a provisional basis the use of daily Kt/V as a measure of continuous renal replacement therapy adequacy for critically ill neonates.
American Journal of Kidney Diseases, 1991
• Continuous venovenous hemofiltration (CVVH) has been used as an alternative to continuous arteriovenous hemofiltration (CAVH) and hemodiafiltration (CAVHD) in the management of critically ill patients with acute renal failure. This report describes our experience with the first 25 patients treated with CVVH at our institution. Vascular access was obtained through a single dual-lumen venous catheter. A blood pump was used to provide ultrafiltration pressure. An ultra filtrate pump was incorporated to ensure predictable ultrafiltrate production rates. Safety features in the extracorporeal circuit included a venous drip chamber with bubble detector and an in-line pressure monitor. CVVH was initiated by a nephrologist and dialysis nurse and was maintained by the intensive care unit (ICU) nursing staff. Fifteen females and 10 males received CVVH therapy for a total of 193.5 days (average, 7.7 ± 10.3 days; range, 0.5 to 48 days). Four of the 25 patients (16%) survived and were discharged from the hospital. Four additional patients (16%) survived the acute phase of their illness, but died from complications of their primary disease before discharge from the hospital. The mean weight change during CVVH was-7.9 ± 7.0 kg (range,-26.5 to +2.9 kg). Metabolic waste products and electrolytes were adequately controlled by CVVH in all but one hypercatabolic patient. The mean heparin dose required was 6.5 ± 4.2 U/kg/h and was adjusted to prevent filter clotting rather than to achieve a predetermined activated partial thromboplastin time (PTT). The median PTT was 35.8 seconds (range, 22.0 to 100; control, 19.5 to 29.5 seconds). Four episodes of volume-responsive hypotension occurred during the 193.5 treatment days. Only one patient experienced a hemorrhagic complication during CWH. No patient experienced a complication related to vascular access. Twelve of 111 total hemofilters were changed because of clot formation. CVVH was well tolerated by patients and managed efficiently by the ICU nursing staff. The incidence of hemorrhagic and vascular access complications in our patients was substantially less than those rates published for CAVH and CAVHD. This low complication rate, together with adequate control of metabolic waste products, suggests that CVVH may be the preferred method of continuous renal replacement therapy in selected acutely ill patients.
Critical Care Medicine, 2004
Objective: Continuous venovenous hemofiltration (CVVH) is used for renal replacement and fluid management in critically ill children. A previous small study suggested that survival was associated with less percent fluid overload (%FO) in the intensive care unit (ICU) before hemofiltration. We reviewed our experience with a large series of pediatric CVVH patients to evaluate factors associated with outcome. Design: Retrospective chart review. Setting: Tertiary children's hospital. Patients: CVVH pediatric ICU patients from November 1997 to January 2003. Interventions: None. Measurements and Main Results: %FO was defined as total fluid input minus output (up to 7 days before CVVH for both hospital stay and ICU stay) divided by body weight. One hundred thirteen patients received CVVH; 69 survived (61%). Multiple organ dysfunction syndrome (MODS) was present in 103 patients; 59 survived (57%). Median patient age was 9.6 yrs (25th, 75th percentile: 2.5, 14.3). Median %FO was significantly lower in survivors vs. nonsurvivors for all patients (7.8% [2.0, 16.7] vs. 15.1% [4.9, 25.9]; p ؍ .02] and in patients with >3-organ MODS (9. . The Pediatric Risk of Mortality Score III at CVVH initiation also was associated with survival in these groups, but by multivariate analysis, %FO was independently associated with survival in patients with >3-organ MODS (p ؍ .01).