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Continuous arteriovenous hemofiltration in premature infants
Insights
Continuous arteriovenous hemofiltration (CAVH) effectively managed fluid overload and metabolic imbalances in critically ill premature infants with acute renal failure (ARF). This safe and simple method showed promising results in a small cohort.
Area of Science:
- Pediatric Nephrology
- Neonatal Intensive Care
- Renal Replacement Therapy
Background:
- Critically ill premature infants often develop acute renal failure (ARF) and hypervolemia.
- Managing fluid and metabolic disturbances in this population presents significant clinical challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous arteriovenous hemofiltration (CAVH) in critically ill premature infants with ARF and hypervolemia.
- To assess CAVH's impact on fluid balance, renal function markers, and overall outcomes.
Main Methods:
- CAVH was implemented in five critically ill premature infants diagnosed with ARF and hypervolemia.
- Prostacyclin was administered to mitigate hemofilter clotting during treatment.
- Treatment parameters including duration, blood flow rates, filtration fractions, and ultrafiltration rates were monitored.
Main Results:
- CAVH successfully corrected fluid overload in all treated infants.
- Mean serum creatinine and urea levels showed minimal changes post-CAVH, indicating stabilization rather than significant clearance.
- Hemofilter clotting occurred approximately every 14 hours, and urinary output was restored in three infants.
- Three infants expired, but deaths were not attributed to ARF or the CAVH procedure.
Conclusions:
- CAVH is a safe and feasible method for managing fluid and metabolic imbalances in critically ill premature infants with ARF.
- The technique demonstrates potential for stabilizing these vulnerable patients, although further research is warranted.
- While CAVH did not significantly alter creatinine or urea levels, it effectively addressed hypervolemia and supported renal function restoration in some cases.
Abstract:
Five critically ill premature infants with acute renal failure (ARF) and hypervolemia were treated by continuous arteriovenous hemofiltration (CAVH). Prostacyclin was used to prevent hemofilter clotting. Mean treatment duration was 53.6 +/- 14 h. Mean blood flow rates of 1.6 +/- 0.22 ml/min and filtration fractions of 17.2 +/- 3.7% produced mean ultrafiltration rates of 8.3 +/- 3.1 ml/kg.h. Fluid overload was easily corrected by means of CAVH. The mean prehemofiltration serum creatinine and urea levels were 2.3 +/- 0.4 and 77 +/- 29.7 mg/dl; the mean posthemofiltration levels were 2.38 +/- 0.43 and 92 +/- 34.4 mg/dl, respectively. Hemofilter clotting occurred every 14 h. Urinary output was restored in three infants. Three of the five infants died, but none of the deaths was related to ARF or CAVH. CAVH is a safe and simple method to control fluid and metabolic imbalances in critically ill premature infants.