净流体平衡影响儿科连续脏替代疗法释放
Sameer Thadani1,2, Harsha V Jujjavarapu3, Christin Silos2
1Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, TX.
Critical care medicine
|March 18, 2025
概括
在儿科连续置换疗法 (CRRT) 中,流体管理是关键. 在CRRT的重症儿童中,净液体平衡 (NFB) 在-4.46和-0.305毫升/千克/小时之间与更好的恢复有关.
科学领域:
- 儿科脏病学 儿科脏病学
- 关键护理医学 关键护理医学
- 脏替代疗法治疗 脏替代疗法
背景情况:
- 对于儿科连续置换疗法 (CRRT) 的最佳液体管理策略尚不清楚.
- 超过率 (UFRs) 对儿童CRRT诱导的口腔创伤的影响尚未确定.
- 虽然在CRRT开始时的流体过载 (FO) 与不良结果有关,但CRRT期间净流体平衡 (NFB) 在预测恢复中的作用尚未确立.
研究的目的:
- 调查CRRT期间净流体平衡 (NFB) 与重症儿童恢复之间的关联.
- 探索保存尿液输出 (UOP) 与儿科CRRT患者的结果之间的关系.
- 将儿科CRRT流体管理实践与成人队列中的流体管理实践进行比较.
主要方法:
- 追溯队列研究,包括在两个四级儿科重症监护病房 (PICU) 接受CRRT的儿童和年轻人.
- 收集的数据包括患者人口统计数据,急性损伤状态,流体过载 (FO),净流体平衡 (NFB) 和尿液输出 (UOP).
- 统计分析以确定NFB,UOP和结果之间的关联,例如30天后无CRRT日和主要不良脏事件 (MAKE-30).
主要成果:
- 总共有371名患者被分析,其中96%在CRRT开始时患有急性损伤,28%患有FO>15%.
- 保存UOP (>0.3毫升/公斤/小时) 的患者经历了5.6个更多的CRRT无天,并减少了MAKE-30的几率.
- -4.46和-0.305毫升/公斤/小时之间的NFB独立地与显著更多的无CRRT日 (β2.90) 和MAKE-30的几率下降 (aOR 0.41) 相关.
结论:
- 儿科CRRT超过实践与成人协议有很大的不同.
- 在CRRT期间更积极的NFB与儿童中较少的CRRT无天有关.
- 需要进一步的研究来确定过度的UFR是否会在重症儿童中引起腹腔创伤,旨在个性化CRRT处方以提高结果.
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