Symons Jordan M, Chua Annabelle N, Somers Michael J G, Baum Michelle A, Bunchman Timothy E, Benfield Mark R, Brophy Patrick D, Blowey Douglas, Fortenberry James D, Chand Deepa, Flores Francisco X, Hackbarth Richard, Alexander Steven R, Mahan John, McBryde Kevin D, Goldstein Stuart L
Department of Pediatrics, University of Washington School of Medicine and Children's Hospital & Regional Medical Center, Seattle, Washington 98105, USA.
Clin J Am Soc Nephrol. 2007 Jul;2(4):732-8. doi: 10.2215/CJN.03200906. Epub 2007 May 18.
This article reports demographic characteristics and intensive care unit survival for 344 patients from the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry, a voluntary multicenter observational network.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Ages were newborn to 25 yr, 58% were male, and weights were 1.3 to 160 kg. Patients spent a median of 2 d in the intensive care unit before CRRT (range 0 to 135). At CRRT initiation, 48% received diuretics and 66% received vasoactive drugs. Mean blood flow was 97.9 ml/min (range 10 to 350 ml/min; median 100 ml/min); mean blood flow per body weight was 5 ml/min per kg (range 0.6 to 53.6 ml/min per kg; median 4.1 ml/min per kg). Days on CRRT were <1 to 83 (mean 9.1; median 6). A total of 56% of circuits had citrate anticoagulation, 37% had heparin, and 7% had no anticoagulation.
Overall survival was 58%; survival differed across participating centers. Survival was lowest (51%) when CRRT was started for combined fluid overload and electrolyte imbalance. There was better survival in patients with principal diagnoses of drug intoxication (100%), renal disease (84%), tumor lysis syndrome (83%), and inborn errors of metabolism (73%); survival was lowest in liver disease/transplant (31%), pulmonary disease/transplant (45%), and bone marrow transplant (45%). Overall survival was better for children who weighed >10 kg (63 versus 43%; P = 0.001) and for those who were older than 1 yr (62 versus 44%; P = 0.007).
CRRT can be used successfully for a wide range of critically ill children. Survival is best for those who have acute, specific abnormalities and lack multiple organ involvement; sicker patients with selected diagnoses may have lower survival. Center differences might suggest opportunities to define best practices with future study.
本文报告了来自前瞻性儿科连续性肾脏替代治疗（ppCRRT）注册研究的344例患者的人口统计学特征及重症监护病房生存率，该研究是一个自愿参与的多中心观察性网络。
设计、设置、参与者及测量指标：年龄范围为新生儿至25岁，58%为男性，体重为1.3至160千克。患者在开始连续性肾脏替代治疗（CRRT）前在重症监护病房的中位停留时间为2天（范围0至135天）。在开始CRRT时，48%的患者接受利尿剂治疗，66%的患者接受血管活性药物治疗。平均血流量为97.9毫升/分钟（范围10至350毫升/分钟；中位值100毫升/分钟）；每千克体重的平均血流量为5毫升/分钟（范围0.6至53.6毫升/分钟；中位值4.1毫升/分钟）。接受CRRT的天数为1至83天（平均9.1天；中位值6天）。共有56%的回路采用枸橼酸盐抗凝，37%采用肝素抗凝，7%未进行抗凝。
总体生存率为58%；各参与中心的生存率有所不同。当因合并液体超负荷和电解质失衡而开始CRRT时，生存率最低（51%）。主要诊断为药物中毒（100%）、肾脏疾病（84%）、肿瘤溶解综合征（83%）和先天性代谢缺陷（73%）的患者生存率较高；肝病/移植患者（31%）、肺病/移植患者（45%）和骨髓移植患者（45%）的生存率最低。体重>10千克的儿童总体生存率更高（63%对43%；P = 0.001），1岁以上儿童的总体生存率也更高（62%对44%；P = 0.007）。
CRRT可成功用于各类重症儿童。对于有急性、特定异常且无多器官受累的儿童，生存率最高；患有特定诊断的病情较重患者的生存率可能较低。中心差异可能提示未来研究中确定最佳实践的机会。
