血液滤过与接受体外膜肺氧合治疗的儿童死亡率增加无关。

Hemofiltration is not associated with increased mortality in children receiving extracorporeal membrane oxygenation.

作者信息

Lou Song, MacLaren Graeme, Paul Eldho, Best Derek, Delzoppo Carmel, Butt Warwick

机构信息

1Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia. 2Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. 3Cardiothoracic Intensive Care Unit, National University Health System, Singapore. 4Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 5School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

出版信息

Pediatr Crit Care Med. 2015 Feb;16(2):161-6. doi: 10.1097/PCC.0000000000000290.

DOI:10.1097/PCC.0000000000000290

PMID:25560421

Abstract

OBJECTIVES

To investigate whether the use of continuous renal replacement therapy is independently associated with increased in-hospital mortality in children on extracorporeal membrane oxygenation.

DESIGN

Retrospective, 1:1 propensity-matched cohort study.

SETTING

Tertiary PICU.

PATIENTS

Eighty-six children on extracorporeal membrane oxygenation, 43 of whom also received hemofiltration.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Demographics, pre-extracorporeal membrane oxygenation hemodynamic data, fluid status, and biochemistry tests were collected, as well as duration of extracorporeal membrane oxygenation, blood product use, complications, and mortality. Forty-three children receiving extracorporeal membrane oxygenation and continuous renal replacement therapy were matched to a cohort of 43 children on extracorporeal membrane oxygenation not receiving continuous renal replacement therapy. The main indication for hemofiltration was fluid overload in 29 patients (67.4%), renal failure in nine patients (20.9%), and electrolyte abnormalities in five patients (11.6%). The median duration of hemofiltration was 108 hours (47-209 hr). Patients receiving hemofiltration had a longer duration of extracorporeal membrane oxygenation (127 hr [94-302 hr] vs 121 hr [67-182 hr]; p = 0.05) and received more platelet transfusions (0.91 mL/kg/hr [0.43-1.58 mL/kg/hr] vs 0.63 mL/kg/hr [0.30-0.79 mL/kg/hr]; p = 0.01). There were otherwise no differences in mechanical or patient-related complications between both groups. There was no difference in the proportion of patients who were successfully decannulated (81.4% vs 74.4%; p = 0.44), survived to ICU discharge (65.1% vs 55.8%; p = 0.38), or survived to hospital discharge (62.8% vs 48.8%; p = 0.19) in the controls versus the hemofiltration group.

CONCLUSIONS

In-hospital mortality was similar between children on extracorporeal membrane oxygenation with and without hemofiltration although hemofiltration appeared to be associated with a slight increase in the duration of extracorporeal membrane oxygenation and more liberal platelet transfusions.

摘要

目的

探讨在接受体外膜肺氧合（ECMO）治疗的儿童中，持续肾脏替代治疗（CRRT）的使用是否与住院死亡率增加独立相关。

设计

回顾性1:1倾向匹配队列研究。

地点

三级儿科重症监护病房（PICU）。

患者

86例接受ECMO治疗的儿童，其中43例还接受了血液滤过。

干预措施

无。

测量指标及主要结果

收集人口统计学资料、ECMO治疗前的血流动力学数据、液体状态和生化检查结果，以及ECMO治疗时间、血液制品使用情况、并发症和死亡率。43例接受ECMO和CRRT治疗的儿童与43例接受ECMO但未接受CRRT治疗的儿童进行匹配。血液滤过的主要指征为29例患者（67.4%）存在液体超负荷、9例患者（20.9%）存在肾衰竭、5例患者（11.6%）存在电解质异常。血液滤过的中位持续时间为108小时（47 - 209小时）。接受血液滤过的患者ECMO治疗时间更长（127小时[94 - 302小时] vs 121小时[67 - 182小时]；p = 0.05），且接受的血小板输注更多（0.91 mL/kg/小时[0.43 - 1.58 mL/kg/小时] vs 0.63 mL/kg/小时[0.30 - 0.79 mL/kg/小时]；p = 0.01）。两组在机械性或与患者相关的并发症方面无其他差异。在对照组和血液滤过组中，成功拔管的患者比例（81.4% vs 74.4%；p = 0.44）、存活至ICU出院的患者比例（65.1% vs 55.8%；p = 0.38）或存活至医院出院的患者比例（62.8% vs 48.8%；p = 0.19）均无差异。