Continuous veno-venous hemodiafiltration in children after cardiac surgery

Jander, Anna; Tkaczyk, Marcin; Pągowska‐Klimek, Izabela; Pietrzykowski, Witold D.; Moll, J; Krajewski, Wojciech; Nowicki, Michał

doi:10.1016/j.ejcts.2007.03.001

Cited by 44 publications

(43 citation statements)

References 24 publications

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“…Carrying out constant HF/HD in infants makes it possible to achieve the necessary fluid balance, and decreases in CVP and Pla are accompanied by MAP and LVEF increases, which allow inotropic support reduction in some cases. [13] We are in strong agreement with researchers who believe that hemodynamic and gas exchange improvements are associated with the optimization of circulating blood volume and plasma colloid osmotic pressure. [5] We also think that blood purification's positive effects are implemented by filtration of interstitial fluid excess and reduction of myocardial and pulmonary edema.…”

Section: Blood Purification For Acute Kidney Injuryin Patients With Msupporting

confidence: 77%

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Yaroustovsky¹,

Abramyan²,

Komardina³

et al. 2017

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How to cite this article: Yaroustovsky M, Abramyan M, Komardina E, Nazarova H. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus 2017;1:49-60.Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra-and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period. Key words:Extracorporeal blood purification, acute kidney injury, acute liver failure, extracorporeal membrane oxygenation, sepsis, selective lipopolysaccharideadsorption, critical condition, cardiovascular surgery ABSTRACT Article history:

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Section: Blood Purification For Acute Kidney Injuryin Patients With Msupporting

confidence: 77%

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Yaroustovsky¹,

Abramyan²,

Komardina³

et al. 2017

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“…It has been reported that 1% -17% of patients with AKI require RRT (3). In this setting, PD or continuous venovenous hemodiafiltration can be offered to (3,4).…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, PD or continuous venovenous hemodiafiltration can be offered to (3,4). In smaller children, PD may have some advantages because it obviates the need for a vascular catheter and is well tolerated in patients with hemodynamic instability (9).…”

Section: Discussionmentioning

confidence: 99%

“…Several conditions increase vulnerability to this complication, including the acute inflammatory response to cardiopulmonary bypass and postoperative hemodynamic instability, ischemia or reperfusion injury, circulating endotoxins and myoglobin, postoperative hemolysis, septic complications, congestive heart failure, and baseline renal disease secondary to cyanotic congenital heart disease. The reported AKI incidence ranges between 1% and 17% (1,2), depending largely on the criteria used to define the condition, and the associated mortality is high (between 21% and 70%) (3).…”

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confidence: 99%

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Use of Peritoneal Dialysis after Surgery for Congenital Heart Disease in Children

et al. 2011

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Acute kidney injury (AKI) is a common complication in children after surgery for congenital heart disease, and peritoneal dialysis (PD) is usually the renal replacement therapy (RRT) of choice, especially in very young children. The aim of the present study was to describe our experience of using PD to treat AKI after cardiac surgery.We retrospectively analyzed children 1 week to 16 years of age undergoing cardiac surgery during 2000 -2008 and found the incidence of AKI treated with PD to be 2.3%. In the 23 patients treated with PD (13 male; average age: 29 ± 48.4 months; weight: 9.1 ± 8.1 kg), the indications for PD initiation were oliguria (n = 13), anuria (n = 9), and acidosis (n = 1). The average time between cardiac surgery and AKI was 4.8 ± 16.8 hours, and between AKI and PD initiation, it was 12 ± 16.8 hours. Patients were treated for a mean of 4.8 ± 3.8 days. Two patients developed peritonitis, and mechanical dysfunction of the PD catheter occurred in 1 patient. In-hospital mortality was 43.4%. Patients treated with PD weighed less (p = 0.004) and had longer bypass time (p = 0.004), inotrope use (p = 0.000), and mechanical ventilation (p = 0.000). However, in a regression analysis, only cardiopulmonary bypass time (odds ratio: 1.021; 95% confidence interval: 0.998 to 1.027; p = 0.032) remained predictive of a subsequent need for PD.We conclude that PD is an efficacious RRT for AKI in children undergoing cardiac surgery and that, in this setting, bypass time is the strongest predictor of a subsequent need for RRT.

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“…To remove the excessive volume and inflammatory mediators, RRT might be necessary to improve prognosis. [28][29][30][31][32][33] It is known that RRT is beneficial to patients with sepsis-related MODS because of its capacity to remove cytokines; early use of RRT might improve prognosis in patients with SIRS and sepsis. [34][35][36][37] It was demonstrated that early initiation of CRRT could improve outcome in AKI patients who underwent cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Analyzing Chinese Patients with Post-Operative Acute Kidney Injury

et al. 2011

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Background: To investigate clinical characteristics and risk factors of Chinese patients with post-operative acute kidney injury (PO-AKI). Methods: Patients with PO-AKI in Ruijin Hospital from December 1997 to December 2005 were retrospectively studied. Results: Patients' mean age was 62.2 ± 18.1 years. There were 111 males and 57 females. The mean serum creatinine at diagnosis was 370.41 ± 320.92 µmol/L and the mean estimated glomerular filtration rate was 33.56 ± 24.24 mL/min. For the outcome of the patients, 38 died and the mortality rate was 22.6%. There were 17 patients (10.1%) with Acute Dialysis Quality Initiative-RIFLE (risk-injury-failure-loss-end classification) phase R, 21 (12.5%) with phase I, and 130 (77.4%) with phase F. There was no significant difference in mortality regarding patients who underwent different types of surgeries. For the risk factors related to PO-AKI, acute tubular necrosis (ATN) increased relative risk of mortality PO-AKI (odds ratio = 7.089, 95% confidence interval = 2.069-24.288, p < 0.001). Multivariate regression models showed that ATN had a positive correlation with mortality of PO-AKI. Conclusions: PO-AKI is one of the most common causes of AKI in patients who underwent operations. Special attention should be paid to risk factors related to PO-AKI in order to improve prognosis.

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Continuous veno-venous hemodiafiltration in children after cardiac surgery

Abstract: We conclude that CVVHDF may be an alternative method of renal support for critically ill children after cardiac surgery in experienced centers, but a significant number of specific complications should be taken into account.

Cited by 44 publications

References 24 publications

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Use of Peritoneal Dialysis after Surgery for Congenital Heart Disease in Children

Analyzing Chinese Patients with Post-Operative Acute Kidney Injury

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