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Pediatric CRRT

Maria J Santiago, Jesús López-Herce, Eva Vierge, Ana Castillo, Amaya Bustinza, Jose M Bellón, Amelia Sánchez, Sarah Fernández
INTRODUCTION: Continuous renal replacement therapies (CRRT) are frequently used in critically ill children and may increase the risk of infection. However, the incidence, characteristics and prognosis of infection in critically ill children on CRRT have not been studied. METHODS: Data from a prospective, single-center register of critically ill children treated with CRRT was analyzed. RESULTS: 55 children (40% under 1 year of age) were treated with CRRT between June 2008 and January 2012; 43 patients (78...
May 18, 2017: International Journal of Artificial Organs
Jeffrey J Cies, Wayne S Moore, Susan B Conley, Paul Shea, Adela Enache, Arun Chopra
An 11-year-old African American male with severe combined immunodeficiency variant, non-cystic fibrosis bronchiectasis, pancreatic insufficiency, chronic mycobacterium avium-intracellulare infection, chronic sinusitis, and malnutrition presented with a 1-week history of fevers. He subsequently developed respiratory decompensation and cefepime was discontinued and doripenem was initiated. Doripenem was the carbapenem used due to a national shortage of meropenem. By day 7 the patient (24.7 kg) had a positive fluid balance of 6925 mL (28% FO), and on days 7 into 8 developed acute kidney injury evidenced by an elevated serum creatinine of 0...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Aadil Kakajiwala, Thomas Jemielita, John Z Hughes, Kimberly Windt, Michelle Denburg, Stuart L Goldstein, Benjamin Laskin
BACKGROUND: Clotting of continuous renal replacement therapy (CRRT) circuits leads to inadequate clearance, decreased ultrafiltration, and increased resource use. We identified factors associated with premature clotting of circuits during CRRT in children. METHODS: In a retrospective cohort of 26 children (median age 11.8 years) receiving 79 CRRT circuits (51 heparin, 22 citrate, 6 using no anticoagulation), we captured hourly pressure, flow, and fluid removal rates along with all activated clotting time (ACT) and circuit ionized calcium measurements...
March 1, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Mayerly Prada Rico, Jaime Fernández Sarmiento, Ana María Rojas Velasquez, Luz Stella González Chaparro, Ricardo Gastelbondo Amaya, Hernando Mulett Hoyos, Daniel Tibaduiza, Ana Maria Quintero Gómez
BACKGROUND: Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia...
November 28, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Tanya Chadha, Thomas Beaulieu, Fredrick Hill, Laura Malaga-Dieguez, Jason Fisher, Arun Chopra
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
Meng-Ju Li, Hsi-Che Liu, Hsiu-Ju Yen, Tang-Her Jaing, Dong-Tsamn Lin, Chao-Ping Yang, Kai-Hsin Lin, Iou-Jih Hung, Shiann-Tarng Jou, Meng-Yao Lu, Chih-Cheng Hsiao, Ching-Tien Peng, Tai-Tsung Chang, Shih-Chung Wang, Ming-Tsan Lin, Jiann-Shiuh Chen, Te-Kau Chang, Giun-Yi Hung, Kang-Hsi Wu, Yung-Li Yang, Hsiu-Hao Chang, Shih-Hsiang Chen, Ting-Chi Yeh, Chao-Neng Cheng, Pei-Chin Lin, Shyh-Shin Chiou, Jiunn-Ming Sheen, Shin-Nan Cheng, Shu-Huey Chen, Yu-Hsiang Chang, Wan-Ling Ho, Yu-Hua Chao, Rong-Long Chen, Bow-Wen Chen, Jinn-Li Wang, Yuh-Lin Hsieh, Yu-Mei Liao, Shang-Hsien Yang, Wan-Hui Chang, Yu-Mei Y Chao, Der-Cherng Liang
BACKGROUND: Reinduction therapy has improved the outcomes in children with acute lymphoblastic leukemia (ALL). We sought to determine the optimal course(s) of reinduction therapy for standard-risk (SR, or "low-risk" in other groups) patients. Also, we evaluated outcomes using triple intrathecal therapy without cranial radiation (CrRT) for central nervous system (CNS) preventive therapy. PROCEDURE: From 2002 to 2012, all newly diagnosed children with ALL in Taiwan were enrolled in Taiwan Pediatric Oncology Group ALL-2002 protocol...
February 2017: Pediatric Blood & Cancer
Wenmin Yang, Jie Hong, Qiyi Zeng, Jianping Tao, Feiyan Chen, Run Dang, Yufeng Liang, Zhiyuan Wu, Yiyu Yang
The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT) for improvement of oxygenation in acute respiratory distress syndrome (ARDS) remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) 24 hours after CRRT onset compared with baseline (median change = 51...
2016: Global Pediatric Health
Jadranka Buturovic-Ponikvar
Citrate has many characteristics of the ideal anticoagulant for hemodialysis. In addition to immediate and complete anticoagulation in the dialysis circuit, citrate has important effects beyond anticoagulation, mainly in reducing inflammatory response induced by hemodialysis. Citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy (CRRT), both for adults and children, with the citrate module being a part of modern CRRT monitors. Although the citrate module is not yet available for intermittent hemodialysis, precise infusion pumps, point-of-care ionometers and high citrate clearance from high flux dialyzers increase safety while reducing the risk of metabolic complications, both in adult and pediatric patients...
June 2016: Therapeutic Apheresis and Dialysis
Leyat Tal, Joseph R Angelo, Ayse Akcan-Arikan
Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Zaccaria Ricci, Francesco Guzzi, Germana Tuccinardi, Stefano Romagnoli
Although universally recognized as a crucial component of renal replacement therapy (RRT), dialytic dose has not been investigated in children with renal failure, differently from the adult population. Consequently, clear indications on the adequacy of continuous RRT in pediatric population is currently missing and wide variations in clinical practice exist worldwide. Fluid balance has been identified as a key factor in affecting outcomes these patients. Nonetheless, the concept and the precise evaluation of the dialytic dose for continuous pediatric RRT seems crucial, especially in light of the small body surface area of neonates and infants that might result into a difficult dose calculation...
April 15, 2016: Minerva Pediatrica
Kimberly Windt
Continuous renal replacement therapy (CRRT) for pediatric patients is an extremely specialized therapy requiring knowledge of the patient's diagnosis, understanding of the principles of the therapy, astute patient assessment, and proficiency with complicated equipment. The complexity of CRRT is compounded by its relatively rare occurrence, in the pediatric population. Maintaining staff competency with this high-risk/low-volume therapy is extremely difficult. This article discusses the development and implementation of a structured system and set of resources to support routine education, and the development of two online, interactive learning modules to provide additional exposure to GRRT throughout the year...
January 2016: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Zaccaria Ricci, Stuart L Goldstein
BACKGROUND: Continuous renal replacement therapy (CRRT) and peritoneal dialysis are the preferred forms of dialysis delivery in critically ill children for the treatment of severe acute kidney injury. The epidemiology and the outcome of acute pediatric dialysis will be reviewed. SUMMARY: The prospective pediatric CRRT (pCRRT) registry has provided important epidemiologic information: pCRRT is required in about 5% of patients in pediatric intensive care units, and the mortality rate of these patients is about 60%...
2016: Contributions to Nephrology
Aadil Kakajiwala, Kathleen Chiotos, Julie Brothers, April Lederman, Sandra Amaral
INTRODUCTION: One of the greatest problems associated with continuous renal replacement therapy (CRRT) is the early clotting of filters. A literature search revealed three case reports of lipemic blood causing recurrent clotting and reduced CRRT circuit survival time in adult patients, but no reports of cases in children. DIAGNOSIS/TREATMENT: A 23-month-old male infant with Martinez-Frias syndrome and multivisceral transplant was admitted to the hospital with severe sepsis and hemolytic anemia...
January 27, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Joan Sanchez-de-Toledo, Alba Perez-Ortiz, Laura Gil, Tracy Baust, Marcos Linés-Palazón, Santiago Perez-Hoyos, Ferran Gran, Raul F Abella
Acute kidney injury (AKI) is frequent in the postoperative period of pediatric heart surgery and leads to significant morbidity and mortality. Renal replacement therapies (RRTs) are often used to treat AKI; however, these therapies have also been associated with higher mortality rates. Earlier initiation of RRT might improve outcomes. This study aims to investigate the relationship between the RRT and morbidity and mortality after pediatric heart surgery. We performed a single-center retrospective study of all children undergoing pediatric heart surgery between April 2010 and December 2012 at a tertiary children's hospital...
April 2016: Pediatric Cardiology
Krishna Mohan Gulla, Anil Sachdev, Dhiren Gupta, Neeraj Gupta, Kanav Anand, P K Pruthi
OBJECTIVE: Scanty literature is available regarding continuous renal replacement therapy (CRRT) utility in severe sepsis with multiorgan dysfunction syndrome (MODS) from developing countries. Author unit's experience in pediatric CRRT is described and outcome of early initiation of CRRT with sepsis and MODS is assessed. MATERIALS AND METHODS: Children aged <16 years with sepsis and MODS who required CRRT from September 2010 to February 2015 were analyzed on demographic factors, timing of initiation of CRRT, mode of CRRT, effect of CRRT onhemodynamics, oxygenation parameters, and outcome...
October 2015: Indian Journal of Critical Care Medicine
Nakano Satoshi, Masaki Osaki, Shinya Miura
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
Kristen Sgambat, Asha Moudgil
Carnitine deficiency is known to occur in chronic hemodialysis; however, the effect of continuous renal replacement therapy (CRRT) on carnitine homeostasis has not been studied. We hypothesized that children receiving CRRT are at risk for deficiency because of continuous removal, absent intake, decreased production, and comorbidities related to critical illness. Records of patients with acute kidney injury receiving CRRT at Children's National Health System between 2011 and 2014 were reviewed for total carnitine (TC), free carnitine (FC), feeding modality, severity of illness, and survival outcome...
January 2016: Hemodialysis International
Claudio Ronco, Zaccaria Ricci, Stuart L Goldstein
The application of continuous renal replacement therapy (CRRT) in children, before roller pumps and dialysis monitors were available in the intensive care unit, was realized by continuous arteriovenous hemofiltration. Then hemofiltration was coupled with dialysis in order to increase dialytic dose and system efficiency, and the circuit and filters were specifically modified to optimize patency and session life span. After about 30 years, another revolution is ongoing, in that pediatric acute kidney injury (AKI) and fluid accumulation (for which critically ill newborns and children with multiple-organ dysfunction are greatly at risk) are recognized as independently associated with mortality and identified as primary conditions to prevent and aggressively treat...
August 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Claudio Ronco, Zaccaria Ricci
INTRODUCTION: More than 20 years have passed since the first clinical application of continuous renal replacement therapy (CRRT) in children. In that revolutionary era, before roller pumps and dialysis monitors for intensive care units were readily available, continuous arteriovenous hemofiltration was the most common treatment for critically ill children. MAJOR FINDINGS: Those steps were the basis for current knowledge about modern CRRT. Research on circuit rheology and filter materials allowed for the improvement of materials, and the optimization of patency and session life spans...
June 2015: Intensive Care Medicine
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