DiCarlo Joseph V, Alexander Steven R, Agarwal Rajni, Schiffman Joshua D
Division of Pediatric Critical Care Medicine, Stanford University Medical School and Lucile Packard Children's Hospital, Palo Alto, California 94304, USA.
J Pediatr Hematol Oncol. 2003 Oct;25(10):801-5. doi: 10.1097/00043426-200310000-00012.
Acute respiratory distress syndrome (ARDS) may result from immunologic activity triggered by irradiation and/or chemotherapy. Hemofiltration removes plasma water and soluble components below 25 kilodaltons. The authors hypothesized that early hemofiltration might attenuate the inflammatory component of ARDS, resulting in increased survival in immunocompromised children and young adults.
Ten children (6 bone marrow transplantation, 3 chemotherapy, 1 lymphoma/hemophagocytosis) with ARDS (Pao2/Fio2 94 +/- 37 torr) received early continuous veno-venous hemodiafiltration as adjunctive therapy for respiratory failure, regardless of renal function. Six children had normal urine output and initial serum creatinine (range 0.1-1.2 mg/dL); four had renal insufficiency (initial creatinine 1.7-2.4 mg/dL). Hemofiltration was instituted coincident with intubation. Respiratory failure was precipitated by Enterobacter sepsis in two patients and by Aspergillus in one.
Hemodiafiltration was performed for 13 +/- 9 days. A high rate of clearance was achieved (52 +/- 17 mL/min/1.73 m2). Duration of mechanical ventilation was 14 +/- 9 days. Nine of the 10 children were successfully extubated; 8 survived.
Early hemofiltration may improve survival from ARDS following bone marrow transplantation or chemotherapy. Possible mechanisms include strict fluid balance, immunomodulation through filtration of inflammatory constituents, and immunomodulation through intensive extracellular water exchange that delivers biochemicals to organs of metabolism as well as the hemofilter.
急性呼吸窘迫综合征（ARDS）可能由放疗和/或化疗引发的免疫活动导致。血液滤过可清除血浆水分和分子量低于25千道尔顿的可溶性成分。作者推测早期血液滤过可能减轻ARDS的炎症成分，从而提高免疫功能低下的儿童和年轻成人的生存率。
10例患有ARDS（动脉血氧分压/吸入氧分数值为94±37托）的儿童（6例进行了骨髓移植，3例接受化疗，1例患有淋巴瘤/噬血细胞综合征）接受了早期连续性静脉-静脉血液透析滤过治疗，作为呼吸衰竭的辅助治疗，无论其肾功能如何。6例儿童尿量正常且初始血清肌酐水平正常（范围为0.1 - 1.2毫克/分升）；4例存在肾功能不全（初始肌酐水平为1.7 - 2.4毫克/分升）。血液滤过在插管时同时开始。2例患者的呼吸衰竭由肠杆菌属败血症引发，1例由曲霉菌引发。
血液透析滤过进行了13±9天。实现了较高的清除率（52±17毫升/分钟/1.73平方米）。机械通气时间为14±9天。10例儿童中有9例成功拔管；8例存活。
早期血液滤过可能提高骨髓移植或化疗后ARDS患者的生存率。可能的机制包括严格的液体平衡、通过滤过炎症成分进行免疫调节，以及通过强化细胞外液交换进行免疫调节，这种交换将生化物质输送到代谢器官以及血液滤过器。
