Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

Vaewpanich, Jarin; Akcan-Arikan, Ayse; Coss‐Bu, Jorge A.; Kennedy, Curtis; Starke, Jeffrey R.; Thammasitboon, Satid

doi:10.3389/fped.2019.00204

Cited by 18 publications

(12 citation statements)

References 29 publications

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“…In a recent prospective study of over 4000 children admitted to pediatric intensive care units (PICUs) across four continents, AKI developed in 26.7% of children of whom 5.8% required renal replacement therapy (RRT) [2], with modalities including peritoneal dialysis, hemodialysis, and continuous RRT (CRRT). Pediatric AKI is associated with prolonged critical care admissions, greater mechanical ventilation needs, and longer overall hospitalizations [3][4][5]. The incidence of chronic kidney disease after pediatric AKI is as high as 20-50% with 10-12% of children requiring chronic dialysis within 5 years after hospital discharge [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Renal replacement therapies for infants and children in the ICU

Sanderson

Harshman

2020

Current Opinion in Pediatrics

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Purpose of review-Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT. Recent findings-The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes. Summary-Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements.

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Section: Introductionmentioning

confidence: 99%

Renal replacement therapies for infants and children in the ICU

Sanderson

Harshman

2020

Current Opinion in Pediatrics

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“…This is in contrast to literature that demonstrates a positive correlation between AKI and FO. 15,17,22,23 This could be because we did not include the KDIGO UO criteria to define and stage AKI, and/or the rise of SCr may have been blunted by hemodilution effects, thus leading to the underdiagnosis of AKI. In the cardiac surgery population, Basu et al revealed an increase in incidence and staging of AKI in infants after correcting SCr for the effects of FO and hemodilution.…”

Section: Discussionmentioning

confidence: 99%

Fluid overload and acute kidney injury in children with tumor lysis syndrome

Flood

Rozmus

Skippen

et al. 2021

Pediatric Blood & Cancer

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Aim: Tumor lysis syndrome (TLS) is a common oncologic emergency among patients with pediatric hematologic malignancies. The mainstay of TLS management is aggressive intravenous hydration. However, the epidemiology of fluid overload (FO) and acute kidney injury (AKI) in this population is understudied. In this study, we aimed to describe the incidence, severity, and complications of FO and AKI among pediatric patients with TLS. Methods:We completed a single-center retrospective cohort study of pediatric patients with a new diagnosis of hematologic malignancy over a 10-year period.Patients with TLS were analyzed in two groups based on the severity of AKI and FO. Charts were reviewed for complications associated with AKI and FO including hypoxemia, mechanical ventilation, hyponatremia, pulmonary edema, pediatric intensive care (PICU) admission, and need for renal replacement therapy (RRT). Results:We analyzed 56 patients with TLS for FO and AKI. We found severe FO (≥10%) occurred in 35.7% (n = 20). PICU admission occurred in 35% of patients with severe FO compared to 8.3% in those with mild/moderate FO <10% (p = .013). Complications of hypoxemia (30% vs. 5.6%, p = .012) and pulmonary edema (25% vs. 2.8%, p = .010) were more common among those with severe FO. AKI occurred in 37.5%(n = 21) patients and resulted in a significant increase in PICU admission and requirement for RRT (p = .001 and <.001, respectively). Conclusion:Our results show FO and AKI are common, and often unrecognized complications of TLS associated with increased morbidity. Prospective, multicenter studies are needed to further dissect the burden of FO and AKI within this vulnerable population.

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“…A limited number of studies utilizing one or more of these interventions in adult ICU patients have shown significant decreases in VAE rates. However, a “bundle” of these interventions to fully optimized VAE prevention has not occurred in adults or been similarly identified for children 20 …”

Section: Ventilator‐associated Eventsmentioning

confidence: 99%

Update on ventilation management in the Pediatric Intensive Care Unit

Egbuta

Easley

2021

Pediatric Anesthesia

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Studies have shown that up to 63% of pediatric intensive care unit patients admitted with acute respiratory or cardiorespiratory illness require mechanical ventilation. Mechanical ventilator support can be divided into three phases: initiation, escalation, and resolution. Noninvasive ventilation is typical during the initiation phase in the management of acute pediatric respiratory failure. The major advancements in the use of noninvasive ventilation involve the emergence of high-flow nasal cannula and how widespread the use of high-flow nasal cannula has become in pediatric critical care practice. When high-flow nasal cannula fails, escalation to continuous positive airway pressure or bi-level positive airway pressure is the next step in respiratory care progression. Careful clinical assessment is necessary to avoid delayed escalation between forms of noninvasive support or escalation to intubation and invasive mechanical ventilation. Advancements in conventional mechanical ventilation are centered on optimizing ventilator settings and customizing monitoring with the overarching goal to reduce complications of mechanical ventilation, such as ventilator-induced lung injury. New mechanical ventilator strategies integrating esophageal pressure monitoring, volumetric capnography, and neurally adjusted ventilator assist help to optimize conventional ventilator support. Nonconventional modes of ventilation in the intensive care unit are high-frequency modes and airway pressure release ventilation. Extracorporeal pulmonary support via extracorporeal membrane oxygenation or paracorporeal lung assist devices provides rescue options when conventional and nonconventional methods fail. During resolution of a course of mechanical ventilator support, reliable weaning strategies and extubation readiness testing are lacking in pediatric critical care. Further, timing of tracheostomy, risk reduction in ventilatorinduced lung injury, and decreased sedation requirements in pediatric patients requiring mechanical ventilation in the pediatric intensive care unit are areas of ongoing research.

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Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

Cited by 18 publications

References 29 publications

Renal replacement therapies for infants and children in the ICU

Renal replacement therapies for infants and children in the ICU

Fluid overload and acute kidney injury in children with tumor lysis syndrome

Update on ventilation management in the Pediatric Intensive Care Unit

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