Outcomes of Critically Ill Children Requiring Continuous Renal Replacement Therapy.

Hayes, Leslie; Tofil, Nancy M.; Tolwani, Ashita J.

doi:10.1097/00003246-200612002-00338

Cited by 38 publications

(76 citation statements)

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“…By examining the outcomes in pediatric patients with FO early after cardiac surgery, our study adds to the growing body of evidence that FO is independently associated with increased morbidity (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)27). We found that early FO is common after cardiac surgery in children, occurring 31% of the time, and is associated with a protracted recovery from surgery as evidenced by 3.5 more days in the hospital, two more days on inotropes, and increased prevalence of PMV.…”

Section: Discussionmentioning

confidence: 99%

“…T he degree of fluid overload (FO) at initiation of continuous renal replacement therapy (RRT) is an independent predictor of mortality (1)(2)(3)(4)(5), and pediatric and adult studies have demonstrated the detrimental effect of an excessive positive fluid balance on a variety of disease outcomes. Retrospective adult studies show that elevated net fluid balance is associated with the development of acute respiratory distress syndrome (6,7) and, prospectively, that conservative fluid management in acute lung injury can shorten length of mechanical ventilation (LMV) and length of stay (LOS) (8,9).…”

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confidence: 99%

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Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Hassinger

Wald

Goodman

2014

Pediatric Critical Care Medicine

181

144

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Hassinger

Wald

Goodman

2014

Pediatric Critical Care Medicine

181

144

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“…Sepsis is a prevalent cause of acute kidney injury in critically ill children, often leading to the need for continuous renal replacement therapy (CRRT) and administration of broad‐spectrum antibiotics. However, despite advances in supportive therapies, outcomes in this patient population have not improved with mortality rates exceeding 40% . Pharmacokinetic alterations that occur in critically ill patients receiving CRRT may reduce efficacy of antimicrobial medications and contribute to unimproved outcomes .…”

mentioning

confidence: 99%

“…Specifically, increased capillary leak, renal failure, and aggressive administration of intravenous fluid often causes fluid overload. Fluid overload not only affects drug disposition, but is also associated with increased mortality in critically ill children receiving CRRT . Furthermore, inadequate treatment with antibiotic therapy is significantly predictive of patient mortality in critically ill patients …”

mentioning

confidence: 99%

Meropenem in children receiving continuous renal replacement therapy: Clinical trial simulations using realistic covariates

Nehus

Mouksassi²,

Vinks

et al. 2014

The Journal of Clinical Pharma

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Meropenem is frequently prescribed in children receiving continuous renal replacement therapy (CRRT). Fluid overload is often present in critically ill children and affects drug disposition. The purpose of this study was to develop a pharmacokinetic model to (1) evaluate target attainment of meropenem dosing regimens against P. aeruginosa in children receiving CRRT and (2) estimate the effect of fluid overload on target attainment. Clinical trial simulations were employed to evaluate target attainment of meropenem in various age groups and degrees of fluid overload in children receiving CRRT. Pharmacokinetic parameters were extracted from published literature, and 287 patients from the prospective pediatric CRRT registry database provided realistic clinical covariates including patient weight, fluid overload, and CRRT prescription characteristics. Target attainment at 40% and 75% time above the minimum inhibitory concentration was evaluated. Clinical trial simulations demonstrated that children greater than 5 years of age achieved acceptable target attainment with a dosing regimen of 20 mg/kg every 12 hours. In children less than 5, however, increased dosing of 20 mg/kg every 8 hours was needed to optimize target attainment. Fluid overload did not affect target attainment. These in silico model predictions will need to be verified in vivo in children receiving meropenem and CRRT.

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“…Goldstein -g-g:[16] 16.4 ± 13.8%°1 ^S^5-4 34.0 ± 2i.o%od 4°o'-í 40 7} S14^ ^3-o\<^3., Hayes - §-^[23] ' -íl 5-0I 20% oíol-oj ^j¿4 4oj-fo] A^MA A^^ ^A^4 -S.-^* ^^- §-4fe ^o] ^3^-1-^ ^o¿ ^ o;[^ 50.^ 4dit =r SI4.…”

mentioning

confidence: 99%

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit

Choi

Chung

Lee

et al. 2011

Korean J Crit Care Med

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Background:The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pédiatrie intensive care unit.Methods: We retrospectively analyzed 96 patients who required CRRT at a pédiatrie intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.Results: Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6 -72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pédiatrie Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 ± 8.9 and the degree of fluid overload at CRRT (F0%) was 12.9 ± 16.0. The PRISM m score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically signiflcant hemorrhage occurred in 10 patients (10.4%).Conclusions: Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

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Outcomes of Critically Ill Children Requiring Continuous Renal Replacement Therapy.

Cited by 38 publications

References 0 publications

Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Meropenem in children receiving continuous renal replacement therapy: Clinical trial simulations using realistic covariates

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit

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