Continuous Venovenous Hemofiltration in Children Less Than or Equal to 10 kg: A Single-Center Experience

Kaempfen, Sirée; Dutta-Kukreja, Pompa; Mok, Quen

doi:10.1097/pcc.0000000000001030

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…Percentage fluid overload was calculated using the following formula: [(Total Fluid Intake in Liters − Total Fluid Output in Liters) / Admission Weight in Kilograms] × 100. This equation was based on the literature …”

Section: Resultsmentioning

confidence: 99%

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Association Between Fluid Balance and Outcomes in Critically Ill Children

et al. 2018

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IMPORTANCE After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. OBJECTIVE To describe the methods to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. DATA SOURCES Systematic search of MEDLINE, EMBASE, Cochrane Library, trial registries, and selected gray literature from inception to March 2017. STUDY SELECTION Studies of children admitted to pediatric intensive care units that described fluid balance or fluid overload and reported outcomes of interest were included. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS All stages were conducted independently by 2 reviewers. Data extracted included study characteristics, population, fluid metrics, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Narrative description of fluid assessment methods and fluid overload definitions was done. When feasible, pooled analyses were performed using random-effects models. MAIN OUTCOMES AND MEASURES Mortality was the primary outcome. Secondary outcomes included treatment intensity, organ failure, and resource use. RESULTS A total of 44 studies (7507 children) were included in this systematic review and meta-analysis. Of those, 27 (61%) were retrospective cohort studies, 13 (30%) were prospective cohort studies, 3 (7%) were case-control studies, and 1 study (2%) was a secondary analysis of a randomized trial. The proportion of children with fluid overload varied by case mix and fluid overload definition (median, 33%; range, 10%-83%). Fluid overload, however defined, was associated with increased in-hospital mortality (17 studies [n = 2853]; odds ratio [OR], 4.34 [95% CI, 3.01-6.26]; I 2 = 61%). Survivors had lower percentage fluid overload than nonsurvivors (22 studies [n = 2848]; mean difference, −5.62 [95% CI, −7.28 to −3.97]; I 2 = 76%). After adjustment for illness severity, there was a 6% increase in odds of mortality for every 1% increase in percentage fluid overload (11 studies [n = 3200]; adjusted OR, 1.06 [95% CI, 1.03-1.10]; I 2 = 66%). Fluid overload was associated with increased risk for prolonged mechanical ventilation (>48 hours) (3 studies [n = 631]; OR, 2.14 [95% CI, 1.25-3.66]; I 2 = 0%) and acute kidney injury (7 studies [n = 1833]; OR, 2.36 [95% CI, 1.27-4.38]; I 2 = 78%). CONCLUSIONS AND RELEVANCE Fluid overload is common and is associated with substantial morbidity and mortality in critically ill children. Additional research should now ideally focus on interventions aimed to mitigate the potential for harm associated with fluid overload.

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Section: Resultsmentioning

confidence: 99%

“…Shown is the association with mortality, stratified by case mix. Included were 22 studies . ALI indicates acute lung injury; CRRT, continuous renal replacement therapy; %FO, percentage fluid overload; and OR, odds ratio.…”

Section: Resultsmentioning

confidence: 99%

Association Between Fluid Balance and Outcomes in Critically Ill Children

et al. 2018

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“…The neck veins are preferred sites for patients weighing less than 5 kg [ 14 ]. In the studies of Kaempfen et al [ 13 ] and Symons et al [ 10 ], the most frequently used catheter sites were the femoral vein in CRRT studies performed in children weighing less than or equal to 10 kg. Unlike their results, in this multicenter study, we observed that the RJVI was the most used site for vascular access.…”

Section: Discussionmentioning

confidence: 99%

“…(VIS = dopamine dose [μg/kg/min] + dobutamine dose [μg/kg/min] + 100 × epinephrine dose [μg/kg/min] + 10 × milrinone dose [μg/kg/min] + 10,000 × vasopressin dose [U/kg/min] + 100 × norepinephrine dose [μg/kg/min]) [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg

Gün¹,

Gurbanov²,

Nakip³

et al. 2023

Turkish Journal of Medical Sciences

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Background/aim This study aimed to investigate the clinical features, modality, complications, and effecting factors on the survival of children weighing up to 10 kg who received continuous renal replacement therapy (CRRT). Materials and methods This study was a retrospective observational study conducted in five pediatric intensive care units in tertiary hospitals in Turkey between January 2015 and December 2019. Results One hundred and forty-one children who underwent CRRT were enrolled in the study. The median age was 6 (range, 2–12) months, and 74 (52.5%) were male. The median weight of the patients was 6 (range, 4–8.35) kg and 52 (36.9%) weighed less than 5 kg. The most common indication for CRRT was fluid overload in 75 (53.2%) patients, and sepsis together with multiorgan failure in 62 (44%). The overall mortality was 48.2%. Conclusion Despite its complexity, CRRT in children weighing less than 10 kg is a beneficial, lifesaving extracorporeal treatment modality.

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“…Medications, transfusions, and total parenteral nutrition (TPN) also significantly increase the daily fluid intake. Previous studies have shown that FO is associated with worse outcomes in children [9][10][11][12][13][14]. In a study of HCT recipients with acute kidney injury (AKI), Michael et al [9] found increased mortality among patients with >10% FO compared with those with <10% FO.…”

Section: Q1 How Should Fluid Status Be Managed In Children Undergoinmentioning

confidence: 99%

Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplant Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents: Part 2—Focus on Ascites, Fluid and Electrolytes, Renal, and Transfusion Issues

Mahadeo

McArthur

Adams

et al. 2017

Biology of Blood and Marrow Transplantation

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Even though hepatic veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic cell transplantation (HCT), there is paucity of research on the management of associated multiorgan dysfunction. To help provide standardized care for the management of these patients, the HCT Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators and the Supportive Care Committee of the Pediatric Blood and Marrow Transplant Consortium, collaborated to develop evidence-based consensus guidelines. After conducting an extensive literature search, in part 2 of this series we discuss the management of fluids and electrolytes, renal dysfunction; ascites, pleural effusion, and transfusion and coagulopathy issues in patients with VOD. We consider the available evidence using the GRADE criteria.

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Continuous Venovenous Hemofiltration in Children Less Than or Equal to 10 kg: A Single-Center Experience

Abstract: We have shown that continuous venovenous hemofiltration can be performed with good outcomes in children less than or equal to 10 kg using relatively high blood flow rates and with the current equipment available.

Cited by 9 publications

References 17 publications

Association Between Fluid Balance and Outcomes in Critically Ill Children

Association Between Fluid Balance and Outcomes in Critically Ill Children

Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg

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