Killick Caroline J, Oberender Felix, Ganu Subodh, Gibbons Kristen
Paediatric Intensive Care Unit, Monash Children's Hospital, Clayton, VIC, Australia.
Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
Crit Care Resusc. 2024 Nov 22;26(4):271-278. doi: 10.1016/j.ccrj.2024.08.007. eCollection 2024 Dec.
The objective of this study was to describe current use, clinical practice, and outcomes of continuous renal replacement therapy (CRRT) in children in the intensive care unit (ICU) in Australia and New Zealand.
retrospective, binational registry-based cohort study and electronic survey of clinical practice.
ICUs that contribute to the Australian and New Zealand Paediatric Intensive Care Registry and a survey conducted in November 2021 including ICUs accredited for paediatric intensive care training that provide CRRT for children were part of this study.
Patients aged <18 years who received renal replacement therapy (RRT) in the ICU were included. Analysis of Australian and New Zealand Paediatric Intensive Care Registry data encompassed admissions from 1 January 2016 to 31 December 2020.
None.
1378 of 58,736 (2.4%) ICU admissions received RRT (CRRT or peritoneal dialysis [PD]), of which 592 (1.0%) received CRRT. Patients receiving CRRT were older and had a median age of 43 months (interquartile range: 7-130 months) compared to 0.3 months (interquartile range: 0.1-2.6 months) for PD. CRRT was used more commonly in all patient groups (523/626, 84%), except those with congenital heart disease (CHD). The number of admissions receiving CRRT varied between units from 1 to 160 admissions for the 5-year period. Overall ICU mortality for CRRT was 30% (175/592). ICU mortality was the highest in neonates ([51/108] 47%) and in those with CHD ([40/69] 58%). ICU mortality for CRRT decreased over the 5-year study period (35%-22%, = 0.025). The survey showed consistency in CRRT equipment used between units, but there were differences in choice of dialytic modality and anticoagulation regimen.
CRRT is used less frequently than PD in smaller children and in those with CHD. In all other cohorts, it is the predominant mode of RRT. ICU mortality rates were higher for CRRT than for PD, with a large variation in mortality rates across age and diagnostic groups. The CRRT mortality in ICU decreased over the 5 years of the study.
本研究的目的是描述澳大利亚和新西兰重症监护病房（ICU）中儿童连续性肾脏替代治疗（CRRT）的当前使用情况、临床实践及治疗结果。
基于两国注册登记的回顾性队列研究及临床实践电子调查。
向澳大利亚和新西兰儿科重症监护注册中心提供数据的ICU，以及2021年11月进行的一项调查（包括为接受CRRT治疗的儿童提供儿科重症监护培训认证的ICU）均纳入本研究。
纳入在ICU接受肾脏替代治疗（RRT）的18岁以下患者。对澳大利亚和新西兰儿科重症监护注册中心数据的分析涵盖了2016年1月1日至2020年12月31日期间的入院病例。
无。
58736例ICU入院患者中有1378例（2.4%）接受了RRT（CRRT或腹膜透析[PD]），其中592例（1.0%）接受了CRRT。接受CRRT的患者年龄较大（中位数年龄43个月，四分位间距：7 - 130个月），而接受PD的患者中位数年龄为0.3个月（四分位间距：0.1 - 2.6个月）。除先天性心脏病（CHD）患者外，CRRT在所有患者组中使用更为普遍（523/626，84%）。在5年期间，各单位接受CRRT的入院病例数从1例到160例不等。CRRT患者的总体ICU死亡率为30%（175/592）。ICU死亡率在新生儿中最高（[51/108] 47%），在CHD患者中也较高（[40/69] 58%）。在5年的研究期间，CRRT的ICU死亡率有所下降（35% - 22%，P = 0.025）。调查显示各单位使用的CRRT设备具有一致性，但在透析方式和抗凝方案的选择上存在差异。
在年龄较小的儿童和CHD患者中，CRRT的使用频率低于PD。在所有其他队列中，它是RRT的主要模式。CRRT的ICU死亡率高于PD，且不同年龄和诊断组的死亡率差异很大。在研究的5年中，ICU中CRRT的死亡率有所下降。
