Related Experiment Videos
Continuous arteriovenous renal replacement systems for critically ill children
Insights
Continuous renal replacement therapy (CRRT) effectively managed fluid overload and azotemia in critically ill children. While generally safe, complications like femoral artery thrombosis occurred, with an overall mortality of 35%.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Critically ill pediatric patients often experience oliguria or anuria.
- Fluid overload and azotemia are significant complications in these patients.
- Arteriovenous renal replacement systems offer a potential solution for managing these conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of five different arteriovenous renal replacement systems in critically ill oliguric or anuric children.
- To assess fluid control, urea clearance, and ultrafiltration rates.
- To identify complications associated with these therapies.
Main Methods:
- Utilized five distinct arteriovenous renal replacement systems: SCU, CAVH, suction-supported CAVH, AVHDF, and CAVHD.
- Treated 23 critically ill children over varying patient days for each modality.
- Monitored fluid overload, urea clearances, and ultrafiltration rates.
Main Results:
- Slow continuous ultrafiltration (SCU) provided excellent fluid overload control within 47 ± 17 hours.
- Urea clearances varied from 5.6 ± 2.1 ml/min/m² (CAVH) to 15.3 ± 3.7 ml/min/m² (CAVHD).
- Ultrafiltration rates ranged from 1.6 ± 0.3 to 11.5 ± 2.4 ml/min/m²; femoral artery thrombosis was the main complication.
Conclusions:
- Arteriovenous renal replacement therapies are effective in managing fluid overload and azotemia in critically ill children.
- Different systems offer varying degrees of efficacy in clearance and ultrafiltration.
- While generally safe, potential complications necessitate careful monitoring and patient selection.
Abstract:
Five different arteriovenous renal replacement systems were used to treat 23 critically ill oliguric or anuric children. Slow continuous ultrafiltration (SCU) was carried out for 8 patient days, continuous arteriovenous haemofiltration (CAVH) for 40, suction-supported CAVH for 56, continuous or intermittent arteriovenous haemodiafiltration (AVHDF) for 3, and continuous arteriovenous haemodialysis (CAVHD) for 24 days. SCU allowed excellent control of fluid overload in 4 patients within 47 +/- 17 h. Urea clearances ranged from 5.6 +/- 2.1 ml/min per m2 (spontaneous CAVH) to 15.3 +/- 3.7 ml/min per m2 (CAVHD) and enabled good control of azotaemia. Ultrafiltration rates of the different filters ranged from 1.6 +/- 0.3 to 11.5 +/- 2.4 ml/min per m2. The only serious complication was a femoral artery thrombosis in a 1.5-year-old boy. Minor side-effects were local bleeding at the entrance site of the arterial catheter and transient hypotension during suction-supported CAVH. Of 23 patients, 8 died because of progressive multiple organ system failure, a mortality of 35%.