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Continuous renal replacement therapy results in respiratory and hemodynamic beneficial effects in pediatric patients
Navyn Naran1, Mayer Sagy, Kevin R Bock
1Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
Insights
Continuous renal replacement therapy (CRRT) did not significantly improve outcomes for mechanically ventilated pediatric patients with systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction. However, their condition did not worsen during the 48-hour treatment period.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care Medicine
Background:
- Systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction are associated with proinflammatory mediators.
- These mediators are removable via hemodiafiltration, a mode of continuous renal replacement therapy (CRRT).
Discussion:
- This retrospective study evaluated 48 hours of CRRT in mechanically ventilated pediatric patients with SIRS and multiorgan dysfunction.
- Key outcome measures included changes in body weight, oxygenation indices, and vasopressor scores.
Key Insights:
- CRRT did not significantly alter body weight, oxygenation, or vasopressor requirements in patients with SIRS and multiorgan dysfunction.
- Survival rates were poor, particularly in patients with five organ system dysfunctions (0% survival).
- Fifty percent survival was observed in patients with three or four organ system dysfunctions.
Outlook:
- Mechanically ventilated patients with SIRS and multiorgan dysfunction showed an insignificant response to 48 hours of CRRT.
- Patient clinical status did not deteriorate during CRRT.
- Further prospective studies are needed to establish the efficacy of CRRT in this patient population.
Background:
Proinflammatory mediators have been implicated in the pathogenesis of systemic inflammatory response syndrome and multiorgan system dysfunction. These mediators are of molecular weights that render them amenable to clearance by the hemodiafiltration mode of continuous renal replacement therapy.
Objective:
To determine whether a period of 48 hrs of continuous renal replacement therapy in patients with multiorgan system dysfunction secondary to systemic inflammatory response syndrome improves their degree of anasarca as well as their cardiovascular and respiratory systems performances.
Data Source:
Retrospective chart review.
Study Design:
Charts of patients diagnosed with systemic inflammatory response syndrome, who were mechanically ventilated in the pediatric intensive care unit and at the same time were receiving continuous renal replacement therapy, from 2004 to 2008, were reviewed. Patients with preexisting renal failure and/or received extracorporeal membrane oxygenation were excluded. Changes in the patients' body weights, oxygenation indices, and vasopressor scores were used as markers for responsiveness to continuous renal replacement therapy. DATA ANALYSIS AND MAIN RESULTS: Data from twenty-two patients with systemic inflammatory response syndrome and with three to five concomitantly diagnosed organ system dysfunctions, at the time continuous renal replacement therapy was initiated, were analyzed. None of the six patients who had five organ system dysfunctions survived to be discharged from the pediatric intensive care unit. Of the remaining 16 patients with three or four organ system dysfunctions, eight (50%) survived and eight (50%) died. The patients' weight, oxygenation indices, and vasopressor scores did not significantly change with 48 hrs of continuous renal replacement therapy.
Conclusions:
Mechanically ventilated patients with systemic inflammatory response syndrome and multiorgan system dysfunction demonstrated a precarious and insignificant response to 48 hrs of continuous renal replacement therapy in a hemodiafiltration mode. However, the patients' overall clinical status did not deteriorate during this therapy. More prospective studies are necessary to determine the effectiveness of continuous renal replacement therapy in patients with multiorgan system dysfunction.
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