BACKGROUNDContinuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region.OBJECTIVEDetermine the outcome of CRRT among critically ill children.DESIGNRetrospective cohort study.SETTINGPediatric intensive care unit.PATIENTS AND METHODSThe study included critically ill children 1–14 years of age who underwent CRRT from July 2009 to June 2015. We report the underlying diagnosis, demographics, indications and modality of CRRT, and associated risk factors. Statistical analyses were used to identify risk factors associated with mortality.MAIN OUTCOME MEASURESMortality and associated risk factors with use of CRRT.SAMPLE SIZE96RESULTSThe mean age was 6.0 (standard deviation, 4.4) years, with a male preponderance in the age group from 1–10 years which comprised almost 60% of the study group. The most common primary diagnoses were malignancies [37.5% (36/96)] followed by primary renal diseases [19.8% (19/96)], and immunodeficiency [16.7% (16/96)]. The most common indication for CRRT was fluid overload [67.2% (65/96)] followed by tumor lysis syndrome [18.8%(18/96)], and metabolic encephalopathy [9.4%(9/96)]. The median length of CRRT was 66 hours (IQR, 35.5–161.4), with a median average circuit life of 30.9 hours (IQR, 16.4–45.0). The most common CRRT catheter site was the internal jugular vein [77.1% (74/96)], followed by the femoral vein [18.8%(18/96)] with continuous venovenous hemodiafiltration [82.3%(79/96)] being the most common CRRT modality used. The mortality rate among critically ill children requiring CRRT was 50% (48/96). There was an increased mortality rate among children with hematological diseases (100%, 10/10), immunodeficiency (86.6%, 13/16) and in children who had undergone stem cell transplantation (90.0%, 27/30), with the least mortality in primary renal disease (15.8% (3/19). We identified septic shock and use of inotropic support as being independently associated with mortality in a multivariate analysis.CONCLUSIONThe overall mortality rate among critically ill children who underwent CRRT was 50% with significantly increased mortality among patients with hematological diseases, immunodeficiency, and in children who had undergone stem cell transplantation. Septic shock and use of inotropic support were associated with mortality.LIMITATIONSRetrospective and single center data that is not generalizable.
The available literature and our past experience indicate that a prefilter ionized calcium < or =0.4 mmol/L is required to anticoagulate a CRRT circuit; a prefilter serum citrate concentration of 6 mmol/L is required to achieve this. Our multiple regression analysis can be expressed graphically to allow easy calculation of the required citrate flow rate, given the knowledge of the replacement flow rate and blood flow rate. Our results provide the first guidelines for the use of citrate as a regional anticoagulant in a pediatric-size model of CRRT.
This study presents a novel approach to enhance expert panel discussions in a medical conference through the use of ChatGPT-4 (Generative Pre-trained Transformer version 4), a recently launched powerful artificial intelligence (AI) language model. We report on ChatGPT-4's ability to optimize and summarize the medical conference panel recommendations of the first Pan-Arab Pediatric Palliative Critical Care Hybrid Conference, held in Riyadh, Saudi Arabia. ChatGPT-4 was incorporated into the discussions in two sequential phases: first, scenarios were optimized by the AI model to stimulate in-depth conversations; second, the model identified, summarized, and contrasted key themes from the panel and audience discussions. The results suggest that ChatGPT-4 effectively facilitated complex do-not-resuscitate (DNR) conflict resolution by summarizing key themes such as effective communication, collaboration, patient and family-centered care, trust, and ethical considerations. The inclusion of ChatGPT-4 in pediatric palliative care panel discussions demonstrated potential benefits for enhancing critical thinking among medical professionals. Further research is warranted to validate and broaden these insights across various settings and cultures.
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