Use of HF20 membrane in critically ill unstable low-body-weight infants on inotropic support

Liu, Isaac Desheng; Ng, Kar-Hui; Lau, Philip; Yeo, Wee‐Song; Koh, Pei Lin; Yap, Hui-Kim

doi:10.1007/s00467-012-2394-3

Cited by 19 publications

(9 citation statements)

References 8 publications

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“…Following the ppCRRT evaluation, CRRT equipment evolved with the introduction of a new generation of machines now in use with better safeguards in place for delivery of CRRT to smaller patients [ 25 ]. A specialized pediatric CRRT circuit, the PrismaFlex HF20, with an extracorpeal volume of 60 ml [ 26 ] is currently being tested for FDA approval at pediatric centers throughout the USA. CARPEDIEM is RRT equipment with a 27 ml extracorpeal circuit volume and capability to handle blood flow rates 5–50 ml/hr., that once approved should dramatically improve the mechanics of treating the smallest patients [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

et al. 2018

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BackgroundTo evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery.MethodsA retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital.ResultsThree hundred eleven total patients were identified, 38 of whom received concurrent treatment with extracorporeal membrane oxygenation. 273 patients received CRRT only and were compared in two study eras (2004–2008 n = 129; 2009–2013 n = 144). Across eras, mean patient age decreased (9.2 vs 7.7 years, p = 0.08), and the most common principal diagnosis changed from cardiac to liver disease. There was an increase in patients treated with continuous renal replacement therapy between cohorts for acute kidney injury of multi factorial etiology (44% vs 56%) and a decrease in treated patients with sepsis (21% vs 11%, p = 0.04). There was no significant difference in survival to hospital discharge between eras (47% vs 49%). Improvement in outpatient follow-up after discharge amongst survivors was seen between study eras (33% vs 54%).ConclusionsDespite multiple institutional practice changes in provision of CRRT, few changes were seen regarding patient demographics, diseases treated, indications for therapy, and survival over 10 years at a single tertiary care. Recognition of need for follow-up nephrology care following CRRT is improving. Ongoing assessment of the patient population in a changing landscape of care for critically ill pediatric patients remains important.

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Section: Discussionmentioning

confidence: 99%

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

et al. 2018

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“…Interestingly, the quotient filter-surface/BSA was significantly higher in patients who developed hypotension. This fact highlights the relevance that the priming volume of the set has on hemodynamics during connection, as it can represent up to 5 to 10% of the patients’ total blood volume [10]. The priming volume of the circuits that were used in the study ranged from 60 to 152 ml.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children

et al. 2018

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BackgroundContinuous renal replacement therapy (CRRT) is the treatment of choice for critically ill children with acute kidney injury. Hypotension after starting CRRT is frequent but very few studies have analyzed its incidence and clinical relevance.MethodsA prospective, observational study was performed including critically ill children treated with CRRT between 2010 and 2014. Hemodynamic data and connection characteristics were collected before, during, and 60 min after CRRT circuit connection. Hypotension with the connection was defined as a decrease in > 20% of the mean arterial pressure from baseline or when intravenous fluid resuscitation or an increase in vasopressors was required.ResultsOne hundred sixty-one connections in 36 children (median age 18.8 months) were analyzed. Twenty-eight patients (77.8%) were in the postoperative period of cardiac surgery, 94% had mechanical ventilation, and 86.1% had vasopressors. The heparinized circuit priming solution was discarded in 8.7% and infused to the patient in 18% of the connections. The circuit was re-primed in the remaining 73.3% using albumin (79.3%), red blood cells (4.5%), or another crystalloid solution without heparin (16.2%). Hypotension occurred in 49.7% of the connections a median of 5 min after the beginning of the therapy. Fluid resuscitation was required in 38.5% and the dose of vasopressors was increased in 12.4% of the connections. There was no relationship between hypotension and age or weight. Re-priming the circuit with albumin reduced the incidence of hypotension from 71.4 to 44.6% (p = 0.004).ConclusionsHypotension after the connection to CRRT is very frequent in critically ill children. Re-priming the circuit with albumin could improve hemodynamics during connection.

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“…In case of insufficient desired toxin clearance, respondents preferred to change the CKRT modality, followed by increasing the effluent rate (eFigure 3B in Supplement 1). The CKRT dose was calculated mainly (72%) using a weight-based formula (mL/kg/h), and the median (IQR) CKRT dose among the PICUs was 35 (30-50) mL/kg/h in neonates and 30 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)…”

Section: Ckrt Initiation and Terminationmentioning

confidence: 99%

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

et al. 2022

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ImportanceContinuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs.ObjectiveTo describe current CKRT practices across European PICUs.Design, Setting, and ParticipantsThis cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022.Main Outcome and MeasuresDemographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed.ResultsOf 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%).Conclusions and RelevanceThis survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.

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Use of HF20 membrane in critically ill unstable low-body-weight infants on inotropic support

Abstract: CRRT using the HF20 membrane is safe and hemodynamically well tolerated in high-risk, unstable low-body-weight infants with cardiac dysfunction on multiple inotropes.

Cited by 19 publications

References 8 publications

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

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