[Continuous arteriovenous hemofiltration in childhood. Indications and technics].

CAVH is an extracorporal treatment modality by which fluid and solutes can be removed from the body by convective transport. Without using a blood pump the blood passes through the hemofilter driven only by the arteriovenous pressure gradient. From May 1985 to October 1986 18 critically ill children with a mean age of 5.1 years (range 10 days to 18 years) and a mean body weight of 20.8 kg (range 3 to 80 kg) were treated by CAVH. Indications for CAVH were: acute renal failure, multiple organ system failure, diuretic-resistant hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. Five different hemofilter systems with a membrane surface of 0.015 m2 to 0.6 m2 and an extracorporal filling volume of 9 to 70 ml were used. Mean duration of CAVH was 132 h (range 10 to 432 h), for a total time of 2344 h. Mean ultrafiltration rates ranged from 0.34 +/- 0.1 (SD) ml/min (Amicon Minifilter 0.015 m2) to 9.1 +/- 1.47 (SD) ml/min (Gambro FH55 0.6 m2). The application of a continuous negative pressure of 200 mmHg onto the ultrafiltrate line the ultrafiltrate increased from 3.96 +/- 0.62 (SD) ml/min to 13.4 +/- 1.63 (SD) ml/min. CAVH allowed good compensation of azotemia in critically ill children with acute renal failure, rapid correction of severe hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. It was well tolerated by all children. The only complication due to hemofiltration was a femoral artery thrombosis which needed surgical revision.(ABSTRACT TRUNCATED AT 250 WORDS)