Arteriovenous hemofiltration in children with multiple organ system failure.

In the last year nine critically ill children with multiple organ system failure (MOSF) were treated by continuous arteriovenous hemofiltration (CAVH). The mean number of organ systems involved was five per patient (range 4 to 7). Mean duration of hemofiltration was 136 hours (range 10 to 432 h.). Mean ultrafiltration rates of 6.4 +/- 3.0 ml/m2 b.s./min achieved mean serum creatinine levels of 2.39 +/- 1.49 mg/dl. Hypervolemia and pulmonary edema were corrected rapidly by CAVH. Total parenteral nutrition with a mean caloric intake of 62 +/- 15 kcal/kg b.w./day was provided throughout the hemofiltration period. In addition high ultrafiltration rates allowed delivery of large amounts of i.v. medications. CAVH is an ideal extracorporeal renal replacement system to control azotemia, fluid, electrolyte, and acid-base status in critically ill children. It carries the potential to improve survival rate in children with MOSF.