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CVVHD in Pediatrics Multiorgan Dysfunction Syndrome: Bicarbonate‐Based Solutions are Feasible and Safe
Author(s) -
Watanabe Troster Koch A, EJ, VHK.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01279.x
Subject(s) - medicine , hemofiltration , sepsis , renal replacement therapy , dialysis , anesthesia , liver disease , mechanical ventilation , hemodialysis , surgery
OBJECTIVE : To describe continuous veno‐venous hemodiafiltration (CVVHD) procedure in a pediatric critical care unit using bicarbonate‐based solution. PATIENTS AND METHODS : From 06‐2001 to 08‐2002, nine patients were treated by CVVHD, age range 1,7–16 yrs, body weight 9,3–45 kg. Indications criteria: oligoanuria and hypevolemia, hemodynamic instability and impossibility of peritoneal dialysis. The patients' primary diseases were: policystic kidney disease (1/9), SLE (1/9), liver disease (6/9), mediastinal germ cells tumos (1/9). All patients were on mechanical ventilation and on vasopressos support. Pancytopenia was diagnosed in 9/9, and hepatic dysfunction in 8/9 pts. The CVVHD prescription was: blood flow rate: 2–4 ml/min, dialisate and replacement flow rate: 2000 ml/1,73m2/h. Systemic heparin anticoagulation could not be used, and citrate regional anticoagulation (4% trissodium citrate) was used in a patient with normal hepatic function. The duration of procedures was 4–72 hours, and the total time range of CVVHD was 28 hours to 19 days. The solution was prepared in our hospital pharmacy. Prisma system (GAMBRO) and poliacrylonitrile M‐60 hemofilter was used in all patients. RESULTS : CVVHD was effective to control fluid balance and metabolic derangements. Anaphylactoid reaction was observed in one patient. Six patients died of causes other than renal failure (sepsis in 5/6 pts, hepatic failure in 1/6 pts). Three patients are alive, two with normal renal function. CONCLUSION : CVVHD with bicarbonate‐based solutions is feasible and safe and allow metabolic and fluid control in critically ill pediatric patients.