连续脏替代疗法时间和死亡率在重症儿童的关联
Maureen A Banigan1, Garrett Keim2, Danielle Traynor2
1Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA. maureen.banigan@pennmedicine.upenn.edu.
Pediatric nephrology (Berlin, Germany)
|February 23, 2024
概括
在严重急性损伤 (AKI) 的儿童中延迟连续置换疗法 (CKRT) 会增加死亡风险. 早期启动CKRT可能会改善AKI重病儿童的治疗结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 脏替代疗法治疗 脏替代疗法
背景情况:
- 急性损伤 (AKI) 是重症儿童的常见并发症,具有显著的发病率和死亡率.
- 在患有AKI的儿科患者中,启动连续置换疗法 (CKRT) 的最佳时间尚不清楚.
- 本研究研究了儿童重症监护室 (ICU) 患者中CKRT启动时间和死亡率之间的关联.
研究的目的:
- 确定CKRT启动时间与严重AKI儿科患者死亡率之间的关系.
- 确定早期CKRT启动是否与改善的存活率和功能恢复有关.
主要方法:
- 在2013年至2019年期间接受CKRT的儿科患者中进行了一项单中心回顾性队列研究.
- 从KDIGO标准定义的第3阶段AKI开始测量CKRT启动的时间,并连续和分类地分析.
- 评估的主要结果是ICU死亡率.
主要成果:
- 该研究包括99名儿科患者,整体死亡率为39%.
- 在延迟CKRT启动和增加死亡率 (每小时OR1.02,p<0.001) 之间发现了显著的关联.
- 与较早开始的患者相比,在AKI发病后2天以上开始CKRT的患者的死亡率更高,ICU停留时间更长,无AKI日数更少.
结论:
- 在严重的AKI后延迟启动CKRT与儿科患者的死亡率增加独立相关.
- 在这种高风险人群中,早期考虑CKRT可能是一个可行的策略,以减少死亡率并增强功能恢复.
- 需要进一步的研究来确定CKRT启动的最佳时间,因为定义存在异质性.
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