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Continuous arteriovenous haemofiltration in children
J Lopez-Herce1, P Dorao, M A Delgado
1Pediatric Intensive Care Unit, La Paz Children's Hospital, Madrid, Spain.
Insights
Continuous arteriovenous haemofiltration (CAVH) effectively treated acute renal failure and hypervolaemia in critically ill children. This pediatric intensive care intervention demonstrated adequate fluid and solute removal, proving beneficial for patient recovery.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Critically ill children often experience acute oliguric renal failure and hypervolaemia.
- Management of fluid and electrolyte balance is crucial in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy and tolerance of continuous arteriovenous haemofiltration (CAVH) in critically ill children.
- To assess the suitability of CAVH for treating acute renal failure and hypervolaemia in pediatric patients.
Main Methods:
- CAVH was implemented in 7 critically ill children, including a neonate with hydrops foetalis and six with acute renal failure.
- Various filter sizes (Biospal, Renaflo, Gambro, Amicon) were utilized based on patient weight and age.
- Treatment duration ranged from 17 hours to 31 days.
Main Results:
- Adequate water and solute removal was achieved in 6 out of 7 patients.
- One patient required a larger filter surface area for improved efficacy.
- CAVH was generally well-tolerated, with discontinuation due to renal recovery, hypervolaemia improvement, death, or transfer to peritoneal dialysis.
Conclusions:
- Continuous arteriovenous haemofiltration is a valuable therapeutic option for managing acute renal failure and hypervolaemia in critically ill children.
- Appropriate filter selection is important, with potential need for adjustments to optimize treatment outcomes.
- CAVH offers a viable alternative for fluid and solute management in pediatric intensive care settings.
Abstract:
Continuous arteriovenous haemofiltration (CAVH) was used in 7 critically ill children: a premature neonate with hypervolaemia secondary to hydrops foetalis and six children aged 9 days to 7 years with acute oliguric renal failure. Biospal 0.5 m2, Renaflo 0.25 m2, Gambro 0.15 m2 and Amicon 0.015 m2 filters were used according to the weights and ages of the patients. Adequate removal of water and solutes was obtained in 6 patients. One of the patients with the smallest filter needed a change to a filter with a larger surface area to improve water and solute removal. Haemofiltration was maintained for between 17 hours and 31 days and was well tolerated. CAVH was discontinued because of recovery of renal function in three patients, improvement of the hypervolaemic state in one, death in three, and transfer to continuous ambulatory peritoneal dialysis because of chronic renal failure in one patient. CAVH is a useful technique for the treatment of acute renal failure and hypervolaemia in critically ill children.