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[Use of continuous arteriovenous hemofiltration in diuretic-resistant hypervolemia and electrolyte disorders]
Insights
Continuous venovenous hemofiltration (CAVH) effectively treated fluid and electrolyte imbalances in critically ill children with diuretic-resistant hypervolemia. This safe extracorporeal therapy improved outcomes, allowing for extubation and reduced cardiac support in most patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Extracorporeal Therapies
Context:
- Critically ill children often develop diuretic-resistant hypervolemia and electrolyte disturbances.
- Pulmonary edema and cardiac dysfunction are common complications requiring intensive support.
- Limited therapeutic options exist for managing fluid overload in this vulnerable population.
Purpose:
- To evaluate the efficacy and safety of continuous venovenous hemofiltration (CAVH) in oliguric/anuric children with diuretic-resistant hypervolemia.
- To assess CAVH's ability to correct fluid and electrolyte imbalances, including hypercalcemia and hypernatremia.
- To determine the impact of CAVH on the need for mechanical ventilation and inotropic support.
Summary:
- CAVH was performed in 10 children with diuretic-resistant hypervolemia, hypercalcemia, or hypernatremia, many requiring mechanical ventilation and cardiac support.
- The mean duration of CAVH was 51.5 hours, resulting in significant fluid removal and correction of electrolyte disorders within 18-24 hours.
- Seven children were successfully extubated and weaned from cardiac support post-CAVH; two patients died from multiple organ system failure. No hemofiltration-related complications occurred.
Impact:
- CAVH is a safe and effective extracorporeal renal replacement therapy for critically ill children.
- The therapy can be rapidly initiated in pediatric intensive care units and is well-tolerated, even in small children.
- Successful fluid and electrolyte management via CAVH can improve clinical outcomes and reduce the need for intensive supportive care.
Abstract:
CAVH was carried out in 10 olig/anuric children with diuretic resistant hypervolemia. In addition, three children had hypercalcemia and one child hypernatremia. All but one needed artificial ventilation for pulmonary edema and positive inotropic cardiac support. Mean duration of CAVH for correction of fluid- and electrolyte imbalance was 51.5 hours (range 20-144 hours). The mean fluid removal of 1715 +/- 1479 (SD) ml decreased mean body weight from 21.4 +/- 18.9 (SD) kg to 19.2 +/- 17.0 (SD) kg. The electrolyte disorders were corrected within 18-24 hours. After correction of fluid overload and electrolyte imbalance 7 children could be extubated and cardiac support could be stopped. Two children died because of multiple organ system failure. CAVH was well tolerated by all children, no hemofiltration related complications occurred. CAVH is an effective and safe extracorporal renal replacement therapy system to correct fluid- and electrolyte imbalances in critically ill children. It can be installed easily and quickly, can be performed in every pediatric intensive care unit and is well tolerated even by small children.