Department of Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
Research Data & Analytics Department, Miami Children's Health Care System & Research Institute, Miami, FL.
Pediatr Crit Care Med. 2019 Jan;20(1):e1-e9. doi: 10.1097/PCC.0000000000001754.
The objective of this study is to describe the relative frequency of use of continuous renal replacement therapy, intermittent hemodialysis, and peritoneal dialysis and to analyze characteristics and outcomes of critically ill children receiving renal replacement therapies admitted to PICUs that participate in the Virtual PICU (VPS LLC, Los Angeles, CA) registry.
Retrospective, database analysis.
PICUs that participate in the Virtual PICU (VPS LLC) registry.
Critically ill children admitted to PICUs that participate in the Virtual PICU (VPS LLC) registry and received renal replacement therapy from January 1, 2009, to December 31, 2015.
None.
A total of 7,109 cases (53% males) received renal replacement therapy during the study period. The median age was 72.3 months (interquartile range, 8.4-170 mo) and median length of stay was 8.7 days (interquartile range, 3.3-21.2 d). Caucasians comprised 42% of the cohort and blacks and Hispanics were 16% each. Continuous renal replacement therapy was used in 46.5%, hemodialysis in 35.5% and peritoneal dialysis in 18%. Of the 7,109 cases, 1,852 (26%) were postoperative cases (68% cardiac surgical) and 981 (14%) had a diagnosis of cancer. Conventional mechanical ventilation was used in 64%, high-frequency oscillatory ventilation in 12%, noninvasive ventilation in 24%, and extracorporeal membrane oxygenation in 5.8%. The overall mortality was 22.3%. Patients who died were younger 40.8 months (interquartile range, 1.5-159.4 mo) versus 79.9 months (interquartile range, 12.6-171.7 mo), had a longer length of stay 15 days (interquartile range, 7-33 d) versus 7 days (interquartile range, 3-18 d) and higher Pediatric Index of Mortality 2 score -2.84 (interquartile range, -3.5 to -1.7) versus -4.2 (interquartile range, -4.7 to -3.0) (p < 0.05). On multivariate logistic regression analysis, higher mortality was associated with the presence of cancer (32.7%), previous ICU admission (32%), requiring mechanical ventilation (33.7%), receiving high-frequency oscillatory ventilation (67%), or extracorporeal membrane oxygenation (58.4%), admission following cardiac surgical procedure (29.4%), and receiving continuous renal replacement therapy (38.8%), and lower mortality was associated with hemodialysis (9.8%), and peritoneal dialysis (12.3%) (p < 0.0001).
Continuous renal replacement therapy is an increasingly prevalent renal replacement therapy modality used in critically ill children admitted to an ICU. Higher mortality rate with the use of continuous renal replacement therapy should be interpreted with caution.
本研究旨在描述连续性肾脏替代治疗、间歇性血液透析和腹膜透析的相对使用频率，并分析接受肾脏替代治疗的危重症儿童的特征和结局，这些儿童入住了参与虚拟儿科重症监护病房（VPS LLC，洛杉矶，加利福尼亚州）登记处的儿科重症监护病房（PICU）。
回顾性数据库分析。
参与虚拟儿科重症监护病房（VPS LLC）登记处的儿科重症监护病房。
2009 年 1 月 1 日至 2015 年 12 月 31 日期间入住参与虚拟儿科重症监护病房（VPS LLC）登记处并接受肾脏替代治疗的危重症儿童。
无。
共有 7109 例（53%为男性）在研究期间接受了肾脏替代治疗。中位年龄为 72.3 个月（四分位距，8.4-170 个月），中位住院时间为 8.7 天（四分位距，3.3-21.2 天）。队列中的白种人占 42%，黑人和西班牙裔各占 16%。连续性肾脏替代治疗使用率为 46.5%，血液透析使用率为 35.5%，腹膜透析使用率为 18%。在 7109 例患者中，1852 例（26%）为术后病例（68%为心脏手术），981 例（14%）诊断为癌症。64%的患者接受常规机械通气，12%接受高频振荡通气，24%接受无创通气，5.8%接受体外膜氧合。总死亡率为 22.3%。死亡患者的年龄为 40.8 个月（四分位距，1.5-159.4 个月），而非死亡患者的年龄为 79.9 个月（四分位距，12.6-171.7 个月）；住院时间更长 15 天（四分位距，7-33 天），而非 7 天（四分位距，3-18 天）；儿科死亡风险评分 2 分更高 -2.84（四分位距，-3.5 至-1.7），而非-4.2（四分位距，-4.7 至-3.0）（p<0.05）。多变量逻辑回归分析显示，更高的死亡率与癌症（32.7%）、既往 ICU 入院（32%）、需要机械通气（33.7%）、接受高频振荡通气（67%）或体外膜氧合（58.4%）、心脏手术后入院（29.4%）以及接受连续性肾脏替代治疗（38.8%）相关，而较低的死亡率与血液透析（9.8%）和腹膜透析（12.3%）相关（p<0.0001）。
连续性肾脏替代治疗是一种在入住 ICU 的危重症儿童中越来越普遍使用的肾脏替代治疗方式。连续肾脏替代治疗使用率较高与死亡率较高相关，但应谨慎解读。
