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Smaller circuits for smaller patients: improving renal support therapy with Aquadex

Background Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal... Full description

Journal Title: Pediatric nephrology (Berlin West), 2015, Vol.31 (5), p.853-860
Main Author: Askenazi, David
Other Authors: Ingram, Daryl , White, Suzanne , Cramer, Monica , Borasino, Santiago , Coghill, Carl , Dill, Lynn , Tenney, Frank , Feig, Dan , Fathallah-Shaykh, Sahar
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
ID: ISSN: 0931-041X
Link: https://www.ncbi.nlm.nih.gov/pubmed/26572894
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title: Smaller circuits for smaller patients: improving renal support therapy with Aquadex
format: Article
creator:
  • Askenazi, David
  • Ingram, Daryl
  • White, Suzanne
  • Cramer, Monica
  • Borasino, Santiago
  • Coghill, Carl
  • Dill, Lynn
  • Tenney, Frank
  • Feig, Dan
  • Fathallah-Shaykh, Sahar
subjects:
  • Acute Kidney Injury - diagnosis
  • Acute Kidney Injury - physiopathology
  • Acute Kidney Injury - therapy
  • Age Factors
  • Alabama
  • Aquadex™ Machine
  • Article
  • Blood
  • Body Size
  • children
  • continuous veno-venous hemofiltration
  • Critical Illness
  • Equipment Design
  • Filtration
  • Hemofiltration - adverse effects
  • Hemofiltration - instrumentation
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Kidneys, Artificial
  • Medicine
  • Medicine & Public Health
  • Methods
  • Miniaturization
  • Nephrology
  • Original Article
  • Pediatric Nephrology
  • Pediatrics
  • Renal Insufficiency, Chronic - diagnosis
  • Renal Insufficiency, Chronic - physiopathology
  • Renal Insufficiency, Chronic - therapy
  • Renal Support Therapy
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Urology
  • Usage
  • Water-Electrolyte Balance
ispartof: Pediatric nephrology (Berlin, West), 2015, Vol.31 (5), p.853-860
description: Background Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation also increases. CRRT machines with smaller ECV could reduce the risks and improve outcomes. Methods We present a case series of small children ( n  = 12) who received continuous venovenous hemofiltration (CVVH) via an Aquadex™ machine (ECV = 33 ml) with 30 ml/kg/h of prereplacement fluids at Children’s of Alabama between December 2013 and April 2015. We assessed in vitro fluid precision using the adapted continuous veno-venous hemofiltration (CVVH) system. Results We used 101 circuits over 261 days to provide CVVH for 12 children (median age 30 days; median weight 3.4 kg). Median CVVH duration was 14.5 days [interquartile range (IQR) = 10; 22.8 days]. Most circuits were routinely changed after 72 h. Five of 101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient cases of hypothermia, three puncture-site bleedings, one systemic bleed, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from the intensive care unit; six of them (50 %) were discharged home. Conclusions CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe, and efficient renal support to small, critically ill infants.
language: eng
source:
identifier: ISSN: 0931-041X
fulltext: no_fulltext
issn:
  • 0931-041X
  • 1432-198X
url: Link


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titleSmaller circuits for smaller patients: improving renal support therapy with Aquadex
creatorAskenazi, David ; Ingram, Daryl ; White, Suzanne ; Cramer, Monica ; Borasino, Santiago ; Coghill, Carl ; Dill, Lynn ; Tenney, Frank ; Feig, Dan ; Fathallah-Shaykh, Sahar
creatorcontribAskenazi, David ; Ingram, Daryl ; White, Suzanne ; Cramer, Monica ; Borasino, Santiago ; Coghill, Carl ; Dill, Lynn ; Tenney, Frank ; Feig, Dan ; Fathallah-Shaykh, Sahar
descriptionBackground Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation also increases. CRRT machines with smaller ECV could reduce the risks and improve outcomes. Methods We present a case series of small children ( n  = 12) who received continuous venovenous hemofiltration (CVVH) via an Aquadex™ machine (ECV = 33 ml) with 30 ml/kg/h of prereplacement fluids at Children’s of Alabama between December 2013 and April 2015. We assessed in vitro fluid precision using the adapted continuous veno-venous hemofiltration (CVVH) system. Results We used 101 circuits over 261 days to provide CVVH for 12 children (median age 30 days; median weight 3.4 kg). Median CVVH duration was 14.5 days [interquartile range (IQR) = 10; 22.8 days]. Most circuits were routinely changed after 72 h. Five of 101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient cases of hypothermia, three puncture-site bleedings, one systemic bleed, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from the intensive care unit; six of them (50 %) were discharged home. Conclusions CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe, and efficient renal support to small, critically ill infants.
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languageeng
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subjectAcute Kidney Injury - diagnosis ; Acute Kidney Injury - physiopathology ; Acute Kidney Injury - therapy ; Age Factors ; Alabama ; Aquadex™ Machine ; Article ; Blood ; Body Size ; children ; continuous veno-venous hemofiltration ; Critical Illness ; Equipment Design ; Filtration ; Hemofiltration - adverse effects ; Hemofiltration - instrumentation ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Kidneys, Artificial ; Medicine ; Medicine & Public Health ; Methods ; Miniaturization ; Nephrology ; Original Article ; Pediatric Nephrology ; Pediatrics ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - therapy ; Renal Support Therapy ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Urology ; Usage ; Water-Electrolyte Balance
ispartofPediatric nephrology (Berlin, West), 2015, Vol.31 (5), p.853-860
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3Cramer, Monica
4Borasino, Santiago
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6Dill, Lynn
7Tenney, Frank
8Feig, Dan
9Fathallah-Shaykh, Sahar
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0Smaller circuits for smaller patients: improving renal support therapy with Aquadex
1Pediatric nephrology (Berlin, West)
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descriptionBackground Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation also increases. CRRT machines with smaller ECV could reduce the risks and improve outcomes. Methods We present a case series of small children ( n  = 12) who received continuous venovenous hemofiltration (CVVH) via an Aquadex™ machine (ECV = 33 ml) with 30 ml/kg/h of prereplacement fluids at Children’s of Alabama between December 2013 and April 2015. We assessed in vitro fluid precision using the adapted continuous veno-venous hemofiltration (CVVH) system. Results We used 101 circuits over 261 days to provide CVVH for 12 children (median age 30 days; median weight 3.4 kg). Median CVVH duration was 14.5 days [interquartile range (IQR) = 10; 22.8 days]. Most circuits were routinely changed after 72 h. Five of 101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient cases of hypothermia, three puncture-site bleedings, one systemic bleed, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from the intensive care unit; six of them (50 %) were discharged home. Conclusions CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe, and efficient renal support to small, critically ill infants.
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27Pediatric Nephrology
28Pediatrics
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30Renal Insufficiency, Chronic - physiopathology
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32Renal Support Therapy
33Retrospective Studies
34Risk Factors
35Time Factors
36Treatment Outcome
37Urology
38Usage
39Water-Electrolyte Balance
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titleSmaller circuits for smaller patients: improving renal support therapy with Aquadex
authorAskenazi, David ; Ingram, Daryl ; White, Suzanne ; Cramer, Monica ; Borasino, Santiago ; Coghill, Carl ; Dill, Lynn ; Tenney, Frank ; Feig, Dan ; Fathallah-Shaykh, Sahar
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0Askenazi, David
1Ingram, Daryl
2White, Suzanne
3Cramer, Monica
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9Fathallah-Shaykh, Sahar
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date2015-11-16
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issue5
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issn0931-041X
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abstractBackground Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation also increases. CRRT machines with smaller ECV could reduce the risks and improve outcomes. Methods We present a case series of small children ( n  = 12) who received continuous venovenous hemofiltration (CVVH) via an Aquadex™ machine (ECV = 33 ml) with 30 ml/kg/h of prereplacement fluids at Children’s of Alabama between December 2013 and April 2015. We assessed in vitro fluid precision using the adapted continuous veno-venous hemofiltration (CVVH) system. Results We used 101 circuits over 261 days to provide CVVH for 12 children (median age 30 days; median weight 3.4 kg). Median CVVH duration was 14.5 days [interquartile range (IQR) = 10; 22.8 days]. Most circuits were routinely changed after 72 h. Five of 101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient cases of hypothermia, three puncture-site bleedings, one systemic bleed, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from the intensive care unit; six of them (50 %) were discharged home. Conclusions CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe, and efficient renal support to small, critically ill infants.
copBerlin/Heidelberg
pubSpringer Berlin Heidelberg
pmid26572894
doi10.1007/s00467-015-3259-3
oafree_for_read