Nutrition in children with continuous renal replacement therapy

Lozano, Maria José Santiago; Álvarez, Cristina Alonso; Heidbüchel, Caterina Álvarez; Lafever, Sarah Fernández; Garcia, M.J.; Cid, J. López-Herce

doi:10.1016/j.anpede.2019.08.006

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…[ 24 ] Hemodynamically unstable or acutely ill patients cannot tolerate rapid fluctuations in their fluid balance and metabolic rate. [ 25 ] The advantage of CRRT is that it provides more consistent liquid removal over a longer period, less fluctuation, and possibly shorter ECMO duration. In addition, Intermittent hemodialysis often causes ECMO flow to be difficult to maintain, so patients and ECMO circuits are generally better able to tolerate slow fluid clearance of CRRT.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Huang,

Gao,

Chen

et al. 2024

Medicine

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Background: Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute respiratory failure. ECMO’s application has expanded to ICUs, emergency departments, and operating rooms. ECMO patients are at high risk for complications, including acute kidney injury (AKI), often requiring renal replacement therapy (RRT), posing significant management challenges. Methods: From August 2015 to June 2022, 120 patients were cured with veno-venous ECMO (n = 60) or veno-arterial ECMO (VA-ECMO, n = 60) combined with CRRT in our hospital. In the control group (n = 60), the input end (arterial end) of CRRT was connected to the ECMO oxygenator. The reinfusion end (venous end) of CRRT was connected to the oxygenator of ECMO for CRRT + ECMO treatment. In the experimental group (n = 60), the input end (arterial end) of CRRT was connected to the oxygenator of ECMO, and an additional pressure regulating device was installed on the connection of the 2 lines. The observation indexes including clinical therapeutic effect, clinical therapeutic effect, the incidence of complications, and the incidence of complications were compared. Results: There was a notable decrease in serum creatinine, and the differences in blood urea nitrogen, procalcitonin, and C-reactive protein after operation were statistically significant (P < .05). The filter use time in the study group was notably longer (P < .01). There exhibited no remarkable difference in the incidences of bleeding, thrombosis, numbness of hands and feet, metabolic alkalosis, disseminated intravascular coagulation, organ dysfunction syndrome, hyperbilirubinemia, and infection. Conclusion: This study demonstrates that additional pressure regulation devices are installed at the line connection between the CRRT input end and the CRRT return end to ensure that the flow rate of ECMO does not affect the CRRT treatment. ECMO and CRRT provide a safe pressure range so that the ECMO line can be safely connected to the CRRT machine at physiological pressure, reducing the occurrence of complications related to CRRT machine interruption and improving the efficiency of CRRT without affecting the efficiency of ECMO, ensuring patient safety.

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Section: Discussionmentioning

confidence: 99%

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Huang,

Gao,

Chen

et al. 2024

Medicine

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“…Transpyloric enteral nutrition can be useful for managing feeding intolerance in critically ill children (20,32,(41)(42)(43) and can be used in patients receiving ECMO support (26,29,44,45). In our experience, transpyloric EN was used in most patients without complications.…”

Section: Discussionmentioning

confidence: 99%

“…EN may be associated with gastrointestinal complications (20,32–39) but they are usually not severe (40). Mild digestive complications have been reported in adult ECMO patients on EN (abdominal distension, high gastric residual volume, diarrhea, and constipation) (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…High gastric residual volume was considered when gastric content was >50% the volume of enteral nutrition administered in the previous 4 hours ( 20 ). Diarrhea was defined as the presence of >8 liquid stools in infants <3 months of age, >4 liquid stools in 3−12-month-old children, and more than two liquid stools in children >12 months ( 20 ). Constipation was defined as the absence of bowel movements 72 hours after the start of EN ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population. Methods: A retrospective single-center analysis (2006–2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded. Results: One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9–63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years ( P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children. Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality. Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications ( P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN). Conclusions: Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.

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“…CRRT is beneficial for children with ECMO and may improve their nutritional status. Enteral nutrition is well tolerated in children treated with CRRT ( 50 ). During the first 72 h of ECMO, children receiving early CRRT consumed a large amount of protein with no significant change in glucose infusion rate, fat emulsion, or total energy ( 48 ).…”

Section: Nutritional Support During Ecmomentioning

confidence: 99%

Research progress on nutritional support in the neonatal and pediatric populations receiving extracorporeal membrane oxygenation

Zhang,

Zhao,

Jia

2024

Front. Nutr.

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Nutritional support is crucial for the prognosis of children supported by extracorporeal membrane oxygenation (ECMO). This article discusses the latest research progress and guideline recommendations for nutritional support during ECMO. We summarize the nutritional status and evaluation of ECMO patients, nutritional support methods and timing, trace elements, the impact of continuous renal replacement therapy (CRRT), and energy requirements and algorithms. The article shows that malnutrition is high in ECMO patients compared to other critically ill patients, with nearly one-third of patients experiencing a decrease in nutritional indicators. The timing of the initiation of nutrition is very important for the nutritional status of the child. Early enteral nutrition can improve patient prognosis, which is the most commonly used, with parenteral nutrition as a supplement. However, the proportion of enteral nutrition is relatively low, and a stepwise nutrition algorithm can determine when to initiate early enteral nutrition and parenteral nutrition. Malnourishment during critical illness have been associated with increased morbidity as well as increased mortality. Nutritional status should be evaluated at admission by screening tools. In addition, changes in the levels of several metabolites in vivo, such as blood lipids, carnitine, and thiamine, can also reflect the degree of nutritional deficiency in critically ill children. This article provides a reference for the implementation of nutrition of pediatric ECMO patients and further research on nutritional support.

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Nutrition in children with continuous renal replacement therapy

Cited by 3 publications

References 20 publications

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Research progress on nutritional support in the neonatal and pediatric populations receiving extracorporeal membrane oxygenation

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