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Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy
Stuart L Goldstein1, Michael J G Somers, Michelle A Baum
1Department of Pediatrics, Renal Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA. stuartg@bcm.tmc.edu
Kidney International
|January 28, 2005
Summary
Fluid overload is a key risk factor for mortality in critically ill children with multi-organ dysfunction syndrome (MODS) requiring continuous renal replacement therapy (CRRT). Early CRRT initiation and inotropic agents are recommended over aggressive fluid administration.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care Medicine
Background:
- Multi-organ dysfunction syndrome (MODS) and acute renal failure (ARF) are less common in children than adults.
- Existing pediatric ARF literature lacks prospective studies, modality stratification, and consistent controls for illness severity.
- This study addresses these gaps by analyzing outcomes in pediatric MODS patients receiving CRRT.
Purpose of the Study:
- To assess the outcomes of pediatric patients with MODS undergoing continuous renal replacement therapy (CRRT).
- To identify factors influencing survival in this vulnerable population.
- To provide evidence-based recommendations for managing pediatric MODS with ARF.
Main Methods:
- A multicenter study involving 120 pediatric patients with MODS who received CRRT.
- Data analysis included 116 patients with complete information.
- Key variables analyzed: Pediatric Risk of Mortality (PRISM 2) score, central venous pressure (CVP), and % fluid overload (%FO) at CRRT initiation.
Main Results:
- Overall survival rate was 51.7%.
- Common causes for CRRT initiation were sepsis (39.2%) and cardiogenic shock (20%).
- Survivors had significantly lower PRISM 2 scores, CVP, and %FO at CRRT initiation compared to nonsurvivors. %FO remained a significant independent predictor of mortality even after controlling for illness severity.
Conclusions:
- Increased fluid administration from PICU admission to CRRT initiation is a potential independent risk factor for mortality in pediatric MODS patients on CRRT.
- Early CRRT initiation and use of inotropic agents are recommended over aggressive fluid administration to maintain blood pressure.
- This study highlights the importance of fluid management in critically ill children with MODS and ARF.