Outcome in children receiving continuous venovenous hemofiltration
S L Goldstein1, H Currier, Graf Cd
1Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas, USA.
Insights
Continuous venovenous hemofiltration (CVVH) with or without dialysis (D) is crucial for critically ill children with acute renal failure. Early initiation of CVVH/D may improve outcomes, especially when fluid overload is less severe.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Continuous venovenous hemofiltration (CVVH) with or without dialysis (D) is a key supportive therapy for critically ill children with acute renal failure.
- Previous studies often combined CVVH/D with other renal replacement modalities or did not account for illness severity.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients undergoing CVVH/D.
- To control for severity of illness using Pediatric Risk of Mortality (PRISM) scores.
Main Methods:
- A retrospective analysis of 21 pediatric patients (22 CVVH/D courses) was conducted.
- Patients' outcomes were assessed, controlling for illness severity with PRISM scores.
Main Results:
- The survival rate was 42.8% (9 out of 21 patients).
- Survivors had significantly lower fluid overload at CVVH/D initiation (16.4%) compared to nonsurvivors (34.0%), even after controlling for PRISM scores.
- CVVH/D costs represented only 1% of total pediatric intensive care unit (PICU) costs per patient.
Conclusions:
- Early initiation of CVVH/D in critically ill children with acute renal failure may improve outcomes.
- Lesser degrees of fluid overload at initiation correlate with better survival.
- The relatively low cost of CVVH/D supports its consideration as an early intervention.
Objective:
Continuous venovenous hemofiltration (CVVH) alone or with dialysis (D) has become an important supportive therapy for critically ill children with acute renal failure. Previous reports of pediatric patient outcome either mix CVVH/D with other renal replacement modalities or do not examine severity of illness. The current study examines only outcomes of children receiving CVVH/D using Pediatric Risk of Mortality (PRISM) scores to control for severity of illness.
Patients:
Twenty-one patients (mean age: 8.8 +/- 6.3 years; mean weight: 28.3 +/- 20.8 kg) received 22 courses of CVVH/D.
Outcomes:
Nine (42.8%) of 21 patients survived. Nine (75%) of 12 deaths occurred within 25 days of pediatric intensive care unit (PICU) admission. Mean PRISM score at PICU admission and CVVH initiation were 13.1 +/- 5.8 and 15.4 +/- 8.9, respectively. Mean patient weight, age, PRISM score at PICU admission and at CVVH/D initiation, maximum pressor number, estimated glomerular filtration rate at CVVH/D initiation and change in mean airway pressure did not differ between survivors and nonsurvivors. The degree of fluid overload at CVVH/D initiation was significantly lower in survivors (16.4% +/- 13.8%) compared with nonsurvivors (34.0% +/- 21.0%), even when controlled for severity of illness by PRISM score. Mean cost of providing CVVH/D accounted for only 1% of total PICU cost per patient.
Conclusions:
The pattern of early multiorgan system failure and death, minimal relative cost of CVVH/D provision, and potential for improved outcome with initiation of CVVH/D at lesser degrees of fluid overload are factors that may support early initiation of CVVH/D in critically ill children with acute renal failure.
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