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Pediatric CVVHD

Anna Lorenzin, Francesco Garzotto, Alberta Alghisi, Mauro Neri, Dario Galeano, Stefania Aresu, Antonello Pani, Enrico Vidal, Zaccaroa Ricci, Luisa Murer, Stuart L Goldstein, Claudio Ronco
BACKGROUND: The CARdiorenal PEDIatric EMergency (CARPEDIEM) machine was originally designed to perform only continuous venovenous hemofiltration (CVVH) in neonatal and pediatric patients. In some cases, adequate convective clearance may not be reached because of a limited blood flow. In such conditions, the application of diffusive clearance [continuous venovenous hemodialysis (CVVHD)] would help optimize blood purification. In this study, the CARPEDIEMâ„¢ machine was modified to enable the circulation of dialysis through the filter allowing testing of the performance of CARPEDIEMâ„¢ machine in CVVHD...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Zumrut Sahbudak Bal, Fulya Kamit Can, Ayse Berna Anil, Alkan Bal, Murat Anil, Gamze Gokalp, Onder Yavascan, Nejat Aksu
Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonic-clonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days...
August 2016: Pediatric Emergency Care
Rachel F Eyler, Kristin C Klein, Bruce A Mueller
This report details the pharmacokinetics of oseltamivir and oseltamivir carboxylate following administration of high-dose oseltamivir in a critically ill child receiving extracorporeal membrane oxygenation (ECMO) and continuous venovenous hemodialysis (CVVHD). A 6-year-old critically ill male patient suffering from a presumed viral illness was transferred to our institution's pediatric intensive care unit from an outside hospital after developing respiratory failure and cardiomegaly. ECMO and oseltamivir therapy were initiated upon admission, and CVVHD was started on hospital day 3...
April 2012: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
A Mary Vilay, Bruce A Mueller, Hilary Haines, Jeffery A Alten, David J Askenazi
Methotrexate, administered for treatment of pediatric and adult malignancies, is a direct renal toxin, which can lead to renal dysfunction, decreased methotrexate clearance, elevated methotrexate concentrations, and systemic toxicity. Although plasma methotrexate concentrations have been shown to decline precipitously after a single dose of glucarpidase, this drug is investigational and available only through compassionate use. Therefore, alternative treatments for methotrexate removal may be required. We describe a 13-year-old girl (body surface area 1...
January 2010: Pharmacotherapy
Michael Zappitelli, Marisa Juarez, L Castillo, Jorge Coss-Bu, Stuart L Goldstein
PURPOSE: We hypothesized continuous veno-venous hemodialysis (CVVHD) amino acid, trace metals and folate clearance impacts nutrient balance. METHODS: Critically ill children receiving CVVHD were studied prospectively for 5 days. Blood concentrations (amino acids, copper, zinc, manganese, chromium, selenium and folate) were measured at CVVHD initiation, and Days 2 and 5. CVVHD clearance, losses and nutrient balances were calculated on Days 2 and 5. RESULTS: We studied 15 children aged 7...
April 2009: Intensive Care Medicine
Francisco X Flores, Patrick D Brophy, Jordan M Symons, James D Fortenberry, Annabelle N Chua, Steven R Alexander, John D Mahan, Timothy E Bunchman, Douglas Blowey, Michael J G Somers, Michelle Baum, Richard Hackbarth, Deepa Chand, Kevin McBryde, Mark Benfield, Stuart L Goldstein
Pediatric stem cell transplant (SCT) recipients commonly develop acute renal failure (ARF). We report the demographic and survival data of pediatric SCT patients enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry. Since 1 January 2001, 51/370 (13.8%) patients entered in the ppCRRT Registry had received a SCT. Median age was 13.63 (0.53-23.52) years. The primary reasons for the initiation of continuous renal replacement therapy (CRRT) were treatment of fluid overload (FO) and electrolyte imbalance (49%), FO only (39%), electrolyte imbalance only (8%) and other reasons (4%)...
April 2008: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
R Hackbarth, T E Bunchman, A N Chua, M J Somers, M Baum, J M Symons, P D Brophy, D Blowey, J D Fortenberry, D Chand, F X Flores, S R Alexander, J D Mahan, K D McBryde, M R Benfield, S L Goldstein
PURPOSE: Well-functioning vascular access is essential for the provision of adequate CRRT. However, few data exist to describe the effect of catheter size or location on CRRT performance in the pediatric population. METHODS: Data for vascular access site, size, and location, as well as type of anticoagulant used and patient demographic data were gathered from the ppCRRT registry. Kaplan-Meier curves were generated and then analyzed by log-rank test or Cox Proportional Hazards model...
December 2007: International Journal of Artificial Organs
Daiva Parakininkas, Larry A Greenbaum
OBJECTIVES: To compare the clearances of low molecular weight molecules using three modalities of continuous renal replacement therapy (CRRT) at the low blood flow rates typically used in pediatric patients. DESIGN: A controlled, in vitro laboratory study. SETTING: Research laboratory of a health sciences university. SUBJECTS: AN69 dialysis hemofilter. INTERVENTIONS: CRRT was performed using a 0...
May 2004: Pediatric Critical Care Medicine
David J Askenazi, Stuart L Goldstein, I-Fen Chang, Ewa Elenberg, Daniel I Feig
Carbamazepine intoxication is common in the pediatric population. Highly protein-bound, carbamazepine is not removed efficiently through conventional hemodialysis. We describe the use of albumin-enhanced continuous venovenous hemodialysis (CVVHD) in a 10-year-old girl who developed coma and respiratory depression due to an intentional carbamazepine overdose (peak drug level of 44.8 microg/ml; therapeutic range: 8-12 microg/ml). Without intervention, the half-life of drug elimination is 25 to 60 hours in patients who are naive to carbamazepine and 12 to 20 hours in children on chronic carbamazepine therapy...
February 2004: Pediatrics
Timothy E Bunchman, Norma J Maxvold, Patrick D Brophy
BACKGROUND: Continuous venovenous hemofiltration (CVVH) may be preferable over continuous venovenous hemodialysis (CVVHD) in sepsis; however, CVVH use is limited by the lack of commercially produced bicarbonate replacement solutions in the United States. Anticoagulation used for hemofiltration traditionally has been either heparin or citrate based, but to date, citrate protocols have been used predominately in CVVHD. When CVVH has been used with citrate anticoagulation, replacement solutions have had to be custom made in the pharmacy...
December 2003: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Timothy E Bunchman, Norma J Maxvold, Joni Barnett, Anne Hutchings, Mark R Benfield
Fourteen children, newborn to 17 years of age, underwent continuous veno-venous hemofiltration with dialysis (CVVHD), using a new FDA-approved bicarbonate-based calcium-free dialysis solution (Normocarb) in combination with citrate anticoagulation. Dialysis prescription included use of the PRISMA system (Gambro, Lakewood, Colo., USA), with ACD-A (Baxter, Deerfield, Ill., USA) for anticoagulation and Normocarb (Dialysis Solution, Richmond Hills, Ontario, Canada) for dialysate. Diagnosis included 11 children with sepsis and 3 children with tumor lysis syndrome...
March 2002: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
R J Meyer, J T Flynn, P D Brophy, W E Smoyer, D B Kershaw, J R Custer, T E Bunchman
Hemodialysis is the usual recommended treatment for severe lithium intoxication; however, rebound of lithium levels may require repeated hemodialysis treatments. We proposed that the addition of continuous hemofiltration after hemodialysis would prevent rebound by providing ongoing clearance of lithium. We report two pediatric patients with lithium intoxication treated by hemodialysis followed by continuous venovenous hemofiltration with dialysis (CVVHD). Both patients were symptomatic at presentation and had initial lithium levels more than three times the usual therapeutic range...
May 2001: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
N J Maxvold, W E Smoyer, J R Custer, T E Bunchman
HYPOTHESIS: Amino acid (AA) loss is not equivalent on continuous venovenous hemofiltration (CVVH) compared with continuous venovenous hemodiafiltration (CVVHD). Amino acid supplementation may be necessary to adjust for a greater clearance on CVVH to maintain nitrogen balance similar to that of CVVHD. OBJECTIVE: To compare AA losses and nitrogen balance between CVVH and CVVHD in children with acute renal failure. SETTING: Pediatric patients in the pediatric intensive care unit of a tertiary referral center...
April 2000: Critical Care Medicine
N Bleyzac, P Barou, B Massenavette, B Contamin, P Maire, J C Berthier, G Aulagner
The use of intravenous acyclovir can be particularly complicated in pediatric patients with evolving renal impairment, because of intraindividual pharmacokinetic variability linked to the patient's clinical condition. The objective of this study was to use therapeutic drug monitoring data to assess acyclovir intraindividual pharmacokinetic variability during several types of renal replacement therapy. Bayesian adaptive control of acyclovir dosage regimen was performed in a pediatric patient with bone marrow transplant who developed severe renal impairment...
October 1999: Therapeutic Drug Monitoring
K M Klee, N McAfee, K Greenleaf
The nursing interventions necessary to care for this critically ill child were professionally challenging. Meeting the psychosocial, educational, and supportive needs of the family during this period of uncertainty, as well as, providing the dialysis therapy and support for this fragile child demonstrated the unique contributions of professional nursing. All outcomes were met, but the patient's extremely poor myocardial function made dialysis treatments and volume control difficult. The use of CVVHD was instrumental to providing dialysis in a safe, effective manner...
August 1993: ANNA Journal
T E Bunchman, N J Maxvold, D B Kershaw, A B Sedman, J R Custer
Continuous venovenous hemodiafiltration (CVVHD) is not commonly used in pediatric intensive care units due to the lack of suitable equipment needed for this technique of renal replacement therapy (RRT). We have used an adapted hemodialysis machine that includes a blood pump controller, an air leak detector, and a venous pressure monitor over the past year in the pediatric intensive care unit. Blood lines available for hemodialysis were used for CVVHD, limiting the extracorporeal circuit volume to 38 mL, which allows for CVVHD capability in an infant as small as 4...
January 1995: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
D Macdonald, R Martin
CVVHD therapy in critically ill pediatric patients presents many challenges. The ability to maintain hemodynamic stability in the face of multiple fluid and medication requirements made this therapy a successful treatment option. The difficulties often associated with heparin anticoagulation were avoided through the use of citrate, and this was achieved without any bleeding complications. Using a collaborative approach of critical care nurses from one facility and nephrology nurses from another was a unique experience...
June 1995: ANNA Journal
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