Pediatric Continuous Renal Replacement Therapy (PCRRT) expert committee recommendation on prescribing prolonged intermittent renal replacement therapy (PIRRT) in critically ill children

Abstract

Introduction: Recently, prolonged intermittent renal replacement therapies (PIRRT) have emerged as cost-effective alternatives to conventional CRRT and their use in the pediatric population has started to become more prominent. However, there is a lack of consensus guidelines on the use of PIRRT in pediatric patients in an intensive care setting.Methods: A literature search was performed on PubMed/Medline, Embase, and Google Scholar in conjunction with medical librarians from both India and the Cleveland Clinic hospital system to find relevant articles. The Pediatric Continuous Renal Replacement Therapy workgroup analyzed all articles for relevancy, proposed recommendations, and graded each recommendation for their strength of evidence. Results:Of the 60 studies eligible for review, the workgroup considered data from 37 studies to formulate guidelines for the use of PIRRT in children. The guidelines focused on the definition, indications, machines, and prescription of PIRRT.Conclusion: Although the literature on the use of PIRRT in children is limited, the current studies give credence to their benefits and these expert recommendations are a valuable first step in the continued study of PIRRT in the pediatric population.

Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: a Retrospective Cohort Study

“…In our study, PIRRT was associated with prolonged survival in COVID-19 patients with invasive mechanical ventilation. The primary goal of RRT is to compensate for the loss of renal function and associated sequelae, including uremic toxicity, electrolyte disturbances, metabolic acidosis, and volume overload (22, 39). In addition, RRT can also remove cytokines from the bloodstream.…”

“…PIRRT is a widely used blood purification therapy, that achieves a high solute clearance rate through diffusion and convection (44). PIRRT has shown to encompass the benefits of both continuous RRT in terms of hemodynamic stability and intermittent hemodialysis in terms of cost-efficiency in the intensive care unit (22, 45).…”

“…Prolonged intermittent renal replacement therapy (PIRRT), as a cost-effective alternative, has been used in the intensive care unit (ICU) (21, 22). To date, no specific treatment has been confirmed to be effective for COVID-19, and supportive treatment remains essential.…”

Bronchoalveolar lavage under ultrasound monitoring of lungs for the treatment of neonatal atelectasis and lung consolidation

“…Diagnosis and treatment. Disease diagnosis, treatment, initial parameter setting of invasive mechanical ventilation, adjustment during treatment, invasive mechanical ventilation combined with inhaled nitric oxide (INO) treatment, continuous renal replacement therapy (CRRT) and the application of exogenous pulmonary surfactant (PS) (PS for Poractant Alfa Injection, Chiesi Farmaceutici S.p.A.) were all based on the published guidelines and 'Pediatric mechanical ventilation' (1,7,13,14).…”

Short‐term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy

“…Prolonged intermittent renal replacement therapy (PIRRT), a new RRT pattern, combines the characteristics of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (IHD) and is being used in clinic, including in adults and children. [4][5][6] There is currently no uniform and clear definition of PIRRT. It seems that any haemodialysis or haemodiafiltration that combines the characteris- duration of treatment more than 3-4 hours ("prolonged"), but less than 8-12 hours ("intermittent").…”