Five years experience with continuous extracorporeal renal support in paediatric intensive care

Abstract

Continuous arterio-venous haemofiltration (CAVH) and continuous veno-venous haemofiltration (CVVH) were used as renal support in 52 critically ill infants and children with acute renal failure. The majority of the patients were on mechanical ventilation (90%) and needed vasopressor support (85%). Uraemia was satisfactorily controlled with both treatment modes. Post-treatment serum urea levels were not different between survivors (94 +/- 8.8 mg/dl) and non-survivors (99.5 +/- 8.8 mg/dl). There were significant differences between survivors and non-survivors in the mean arterial pressure (64.7 +/- 3.8 vs 48.0 +/- 2.2 mmHg, p less than 0.001), the number of organ system failures (2.9 +/- 0.16 vs 3.8 +/- 0.21, p less than 0.025), and the severity of illness assessed by the acute physiologic score for children (APSC 19.4 +/- 1.9 vs 26.3 +/- 1.9, p less than 0.01). The overall mortality was 48%. The mortality in the CVVH group (65%) was higher than in the CAVH group (40%). Death was significantly related to sepsis (p less than 0.005) and multiple system organ failure (p less than 0.005). A major complication during CAVH was one femoral artery thrombosis after 12 days of treatment. Technical problems were only observed during CVVH. CAVH and CVVH are safe and effective methods of continuous renal support for critically ill paediatric patients with multiple system organ failure. CAVH is simpler, needs no specially trained staff and seems to the ideal renal replacement system for critically ill infants.

Two decades’ experience of renal replacement therapy in paediatric patients with acute renal failure

“…This is in agreement to recent findings that these scores might be prognostic tools [5,11,14,18,19]. In the second decade, the OSF and TISS scores discriminated between 3.7 +/-1.…”

“…These observations suggest less severe diseases in the second decade. The need for vasopressors is associated with a high mortality [2], as well as low MAP [6,18,19] and ventilatory support [6]. In contrast, all infants younger than one year had low MAP and all needed ventilatory and vasopressor support in the second decade [2,6,18,19].…”

Low-volume peritoneal dialysis in 116 neonatal and paediatric critical care patients

“…Haemofiltration is increasingly used, as currently described [18], however, in neonates and infants, treatment with PD still predominates [7]. The fact that there is no need for anticoagulation and gross vascular access represents an important advantage, particularly at this early age, moreover ischaemic and embolic complications associated with haemofiltration [19] are avoided.…”

Continuous veno-venous hemodiafiltration using bicarbonate dialysate

“…Other benefits include relaxation of fluid restrictions and the ability to administer relatively large volumes of parenteral nutrition and intravenous medication. The disadvantages of peritoneal dialysis, such as unpredictable ultrafiltration rate, increased intra-abdominal pressure, and hence increased ventilatory requirements and the risk of peritonitis, are also avoided with this technique [8,12]. CAVH was initially shown to be an attractive technique due to its simplicity, but the risk of arterial bleeding and thrombosis at the femoral arterial 682 [6,12].…”