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Continuous arteriovenous haemofiltration in critically ill children
Insights
Continuous arteriovenous haemofiltration (CAVH) effectively supported critically ill children with acute renal failure. This method helped manage fluid overload and uremia, though survival rates remained challenging due to multiorgan failure.
Area of Science:
- Pediatric Nephrology
- Intensive Care Medicine
- Renal Replacement Therapy
Background:
- Acute renal failure (ARF) is a critical condition in children, often associated with complex medical scenarios like post-cardiac surgery or liver failure.
- Managing fluid balance and uremic toxins is crucial for critically ill pediatric patients with ARF.
Purpose of the Study:
- To evaluate the efficacy and outcomes of continuous arteriovenous haemofiltration (CAVH) in pediatric patients with acute renal failure.
- To assess the role of CAVH in fluid management and uremia control in critically ill children.
Main Methods:
- Retrospective analysis of 24 pediatric patients treated with CAVH between 1987 and 1991 for ARF.
- Utilized femoral vessels for vascular access and various hemofilters based on patient size.
- Monitored ultrafiltration rates and fluid clearance to manage fluid overload and uremia.
Main Results:
- CAVH was indicated for oliguria or fluid overload in all patients.
- Adequate control of uremia was achieved in 18 out of 24 patients.
- Nine children survived with renal function recovery; 15 (62.5%) died from multiorgan failure.
Conclusions:
- Continuous arteriovenous haemofiltration (CAVH) is an effective supportive therapy for critically ill children experiencing acute renal failure.
- While CAVH aids in managing fluid and uremic complications, overall survival is significantly impacted by the severity of underlying multiorgan failure.
Abstract:
We report 24 children with acute renal failure treated with continuous arteriovenous haemofiltration (CAVH) between 1987 and 1991. The median age was 2.9 years (range 3 days to 9 years). The main causes of the acute renal failure were: open heart surgery (n = 11) and liver failure of different origins before and after liver transplantation (n = 10). The indication for CAVH was oliguria or fluid overload in all children. The femoral vessels were used as vascular access in most instances. Different filters were used, depending on the size of the patient and an average ultrafiltration of 130 +/- 89 ml/h was achieved, which resulted in a fluid clearance of 4.0 +/- 2.6 ml/min per 1.73 m2. In 18 patients uraemia was adequately controlled. Nine children survived after recovery of their renal function; 15 (62.5%) died as a consequence of multiorgan failure. We conclude that CAVH is an effective method to support critically ill children with acute renal failure.