Pediatric and Infant Center for Acute Nephrology Children's of Alabama, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Critical Care, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA, USA.
Semin Dial. 2021 Nov;34(6):530-536. doi: 10.1111/sdi.12978. Epub 2021 Apr 28.
The use of kidney support therapy (KST) for use in managing patients with acute kidney injury (AKI) has expanded greatly in the last several decades. The growing use of KST modalities in children, and now in neonates, has been associated with opportunities for education, clinical research, clinical practice improvements, and outcomes research. A multitude of controversies exist in the field of pediatric KST-many of which are shared by adult critical care nephrology practice. Simultaneously, pediatric KST has led the way to a burgeoning exploration of the importance of fluid overload as it relates to KST initiation and management and also with quality improvement. In this review, we will explore and describe the paradigms contained with pediatric KST used to support children with AKI. In addition to the governing principles related to the mechanics of KST, we will describe the novel aspects of newer support machines and ethical considerations of KST provision. Anticoagulation, dose, and modality will be discussed as well as priming procedures for special considerations. The utilization of KST across pediatric populations represents the next frontier of critical care nephrology.
在过去的几十年中，肾脏支持疗法（KST）在治疗急性肾损伤（AKI）患者中的应用大大扩展。儿童，现在包括新生儿，越来越多地使用 KST 模式，这为教育、临床研究、临床实践改进和结果研究提供了机会。儿科 KST 领域存在许多争议——其中许多与成人重症监护肾脏病学实践中存在的争议相同。同时，儿科 KST 也引领了对液体超负荷与 KST 启动和管理以及质量改进之间关系的重要性的探索。在这篇综述中，我们将探讨和描述用于支持患有 AKI 的儿童的儿科 KST 所包含的范例。除了与 KST 力学相关的治理原则外，我们还将描述新型支持机器和 KST 提供的伦理考虑的新颖方面。还将讨论抗凝、剂量和模式以及特殊考虑的预充程序。KST 在儿科人群中的应用代表了重症监护肾脏病学的下一个前沿领域。
