Department of Pediatric Heart Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Thorac Cardiovasc Surg. 2023 Jan;71(S 04):e8-e12. doi: 10.1055/s-0043-1766107. Epub 2023 Apr 10.
Fluid overload is a serious complication in the treatment of infants with extracorporeal membrane oxygenation (ECMO). Volume overload leads to prolonged ECMO therapy if left untreated. The renal replacement therapy of choice in pediatric patients is peritoneal dialysis or conventional dialysis using a "large" hemofiltration machine via a Shaldon catheter or directly connected to the ECMO system. This study describes the implementation of a novel minimized hemodiafiltration (HDF) system in pediatric patients on ECMO.
This retrospective analysis included 13 infants up to 5 kg who underwent 15 veno-arterial (V-A) ECMO runs with HDF. A minimized HDF system is integrated into an existing ECMO system (18-mL priming volume), connected post-oxygenation to the venous line, before the ECMO pump. Two infusion pumps are attached to the inlet and outlet of the hemofilter to control the HDF system.In addition to retention values (creatine and urea) at six defined time points, flow rates, dialysis parameters, and volume withdrawal were examined, as well as the number of HDF system changes.
With a mean ECMO runtime of 156 hours, the HDF system was utilized for 131 hours. The mean blood flow through the hemofilter was 192 mL/min. The mean dialysate flow was 170 mL/h, with a mean volume deprivation of 39 mL/h. The HDF system was changed once in seven cases and twice in three cases.
There were no complications with the minimized HDF system in all 15 applications. It allows safe patient volume management when treating infants with ECMO, with effective elimination of urinary substances.
体外膜肺氧合（ECMO）治疗婴儿时，液体超负荷是一种严重的并发症。如果不加以治疗，容量超负荷会导致 ECMO 治疗时间延长。儿科患者首选的肾脏替代治疗方法是腹膜透析或使用“大型”血液滤过机通过 Shaldon 导管或直接连接到 ECMO 系统进行常规透析。本研究描述了在 ECMO 上的儿科患者中实施新型最小化血液透析滤过（HDF）系统。
这项回顾性分析包括 13 名体重达 5 公斤以下的婴儿，他们进行了 15 次静脉-动脉（V-A）ECMO 运行，其中包括 HDF。最小化的 HDF 系统集成到现有的 ECMO 系统中（初始体积 18 毫升），在氧合后连接到静脉线上，在 ECMO 泵之前。两个输液泵连接到血液滤器的入口和出口，以控制 HDF 系统。除了在六个定义的时间点检查保留值（肌酐和尿素）外，还检查了流速、透析参数和体积去除情况，以及 HDF 系统的更换次数。
平均 ECMO 运行时间为 156 小时，HDF 系统使用了 131 小时。血液滤器的平均血流速度为 192 毫升/分钟。平均透析液流速为 170 毫升/小时，平均体积剥夺量为 39 毫升/小时。在七个病例中，HDF 系统更换了一次，在三个病例中更换了两次。
在所有 15 例应用中，最小化 HDF 系统均无并发症。在治疗 ECMO 婴儿时，它允许安全的患者容量管理，同时有效清除尿中的物质。
