Redant Sébastien, Barbance Océane, Tolwani Ashita, Beretta-Piccoli Xavier, Massaut Jacques, De Bels David, Taccone Fabio S, Honoré Patrick M, Biarent Dominique
Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium.
Departments of Intensive Care, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), 1020 Brussels, Belgium.
Membranes (Basel). 2021 Mar 11;11(3):195. doi: 10.3390/membranes11030195.
The high mortality of pediatric acute respiratory distress syndrome (PARDS) is partly related to fluid overload. Extracorporeal membrane oxygenation (ECMO) is used to treat pediatric patients with severe PARDS, but can result in acute kidney injury (AKI) and worsening fluid overload. The objective of this study was to determine whether the addition of CRRT to ECMO in patients with PARDS is associated with increased mortality.
We conducted a retrospective 7-year study of patients with PARDS requiring ECMO and divided them into those requiring CRRT and those not requiring CRRT. We calculated severity of illness scores, the amount of blood products administered to both groups, and determined the impact of CRRT on mortality and morbidity.
We found no significant difference in severity of illness scores except the vasoactive inotropic score (VIS, 45 ± 71 vs. 139 ± 251, = 0.042), which was significantly elevated during the initiation and the first three days of ECMO. CRRT was associated with an increase in the use of blood products and noradrenaline ( < 0.01) without changing ECMO duration, length of PICU stay or mortality.
The addition of CRRT to ECMO is associated with a greater consumption of blood products but no increase in mortality.
小儿急性呼吸窘迫综合征（PARDS）的高死亡率部分与液体超负荷有关。体外膜肺氧合（ECMO）用于治疗患有严重PARDS的小儿患者，但可能导致急性肾损伤（AKI）并使液体超负荷情况恶化。本研究的目的是确定在PARDS患者中，在ECMO基础上加用连续性肾脏替代治疗（CRRT）是否与死亡率增加相关。
我们对需要ECMO的PARDS患者进行了一项为期7年的回顾性研究，并将他们分为需要CRRT的患者和不需要CRRT的患者。我们计算了疾病严重程度评分、两组输注的血液制品量，并确定了CRRT对死亡率和发病率的影响。
我们发现，除血管活性药物评分（VIS，45±71对139±251，P=0.042）外，疾病严重程度评分无显著差异，在ECMO开始时及最初三天，血管活性药物评分显著升高。CRRT与血液制品和去甲肾上腺素使用量增加相关（P<0.01），但未改变ECMO持续时间、儿科重症监护病房（PICU）住院时间或死亡率。
在ECMO基础上加用CRRT与血液制品消耗量增加相关，但死亡率并未增加。
