Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey.
Department of Pediatric Intensive Care, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey.
J Intensive Care Med. 2019 Nov-Dec;34(11-12):985-989. doi: 10.1177/0885066617724339. Epub 2017 Aug 18.
Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period.
A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors.
The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8.
The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.
连续肾脏替代疗法（CRRT），无论是连续静脉-静脉血液滤过（CVVH）还是血液透析滤过（CVVHD），在危重症儿童中经常使用。许多临床变量和技术问题已知会影响结果。正在寻找可以修改的因素以提高肾脏替代的存活率。作为贡献，我们提供了在 7 年期间接受 CRRT 的 104 例患者的数据。
共纳入 2009 年至 2016 年期间住院的 104 例患者。比较了幸存者和非幸存者之间的人口统计学信息、入院儿科死亡率（PRISM）评分、CRRT 适应证、液体超负荷的存在、CRRT 方式、CRRT 持续时间和儿科重症监护病房（PICU）停留时间。
总体存活率为 51%。有液体超负荷的患者死亡率、CRRT 持续时间和 PICU 停留时间明显增加。与急性肾衰竭和急性代谢性疾病发作相比，多器官功能障碍综合征作为 CRRT 的适应证与存活率降低显著相关。幸存者和非幸存者之间的 CRRT 方式没有差异。该组的标准化死亡率比为 0.8。
在危重症患者中，CRRT 成功地实现了液体清除和纠正器官衰竭或先天性代谢紊乱发作引起的代谢失衡。它对高危 PICU 患者的预期死亡率有积极影响。为了影响结果，应关注在液体超负荷的早期阶段开始治疗。定义导致死亡率的危险因素相对重要性的前瞻性研究可以协助制定影响结果的指南。
