Abstract
Continuous arterio-venous haemofiltration (CAVH) and continuous veno-venous haemofiltration (CVVH) were used as renal support in 52 critically ill infants and children with acute renal failure. The majority of the patients were on mechanical ventilation (90%) and needed vasopressor support (85%). Uraemia was satisfactorily controlled with both treatment modes. Post-treatment serum urea levels were not different between survivors (94±8.8 mg/dl) and non-survivors (99.5±8.8 mg/dl). There were significant differences between survivors and non-survivors in the mean arterial pressure (64.7±3.8 vs 48.0±2.2 mmHg,p<0.001), the number of organ system failures (2.9±0.16 vs 3.8±0.21,p<0.025), and the severity of illness assessed by the acute physiologic score for children (APSC 19.4±1.9 vs 26.3±1.9,p<0.01). The overall mortality was 48%. The mortality in the CVVH group (65%) was higher than in the CAVH group (40%). Death was significantly related to sepsis (p<0.005) and multiple system organ failure (p<0.005). A major complication during CAVH was one femoral artery thrombosis after 12 days of treatment. Technical problems were only observed during CVVH. CAVH and CVVH are safe and effective methods of continuous renal support for critically ill paediatric patients with multiple system organ failure. CAVH is simpler, needs no specially trained staff and seems to the ideal renal replacement system for critically ill infants.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cameron JS (1986) Acute renal failure in the intensive care unit today. Intensive Care Med 12:64–70
Swartz RD (1984) Interventive support for actue renal failure in the critically ill patient. In: Bartlett RH, Whitehouse WM, Turcotte JG, Harper ML (eds) Life support systems in intensive care. Yearbook Medical Publishers, Chicago, pp 409–431
Maxwell LG, Fivush BA, McLean RH (1987) Renal failure. In: Rogers MC (ed) Textbook of pediatric intensive care. Williams and Wilkins, Baltimore, pp 1001–1055
Kramer P, Wigger W, Rieger J, Mathaei D, Scheler F (1977) Arteriovenous hemofiltration: a new and simple method for the treatment of overhydrated patients resistant to diuretics. Klin Wochenschr 55:1121–1122
Lieberman KV (1987) Continuous arteriovenous hemofiltration in children. Pediatr Nephrol 1:330–338
Lopez-Herce J, Dorao P, Delgado MA, Espinosa L, Ruza F, Martinez MC (1989) Continuous arteriovenous haemofiltration in children. Intensive Care Med 15:224–227
Ronco C, Brendolan A, Bragantini L, Chiaramonte S, Feriani M, Fabris A, DellAquila R, La Greca G (1986) Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration. Kidney Int 29:908–915
Leone MR, Jenkins RD, Golper TA, Alexander SR (1986) Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients. Crit Care Med 14:1058–1063
Lauer A, Saccaggi A, Ronco C, Belledonne M, Glabman S, Bosch JB (1983) Continuous arteriovenous hemofiltration in the critically ill patient. Ann Intern Med 99:455–460
Olbricht CJ (1986) Continuous arteriovenous hemofiltration — the control of azotemia in acute renal failure. In: Paganini EP (ed) Acute continuous renal replacement therapy. Nijhoff, Boston, pp 123–141
Favre H, Levy M, Klohn M, Suter PM (1987) Continuous veno-venous hemofiltration. In: Paganini EP (ed) Proceedings of Third International Symposium on Acute Continuous Renal Replacement Therapy. Kidney Foundation, pp 87–93
Zobel G, Kuttnig M, Ring E, Grubhauer HM (1990) Clinical scoring system in children with continuous renal support. Child Nephrol Urol 10:14–17
Wilkinson JD, Pollack MM, Ruttiman UE (1986) Outcome of pediatric patients with multiple organ system failure. Crit Care Med 14:271–274
Cullen DJ, Civetta JM, Briggs BA (1974) Therapeutic intervention scoring system: a method for auantitative comparison of patient care. Crit Care Med 2:57–60
Zobel G, Trop M, Ring E, Grubbauer HM (1987) Continuous arteriovenous hemofiltration in critically ill children with acute renal failure. Crit Care Med 15:699–700
Zobel G, Trop M, Ring E, Grubbauer HM (1987) Arteriovenous hemofiltration in children with multiple organ system failure. Intern J Artif Organs 10:233–238
Schetz M, Lauwers PM, Ferdinande P (1989) Extracorporeal treatment of acute renal failure in the intensive care unit: a critical view. Intensive Care Med 15:349–357
Dickson DM, Brown EA, Kox W (1988) Continuous arteriovenous haemodialysis (CAVHD): a new method of complete renal replacement therapy in the critically ill patient. Intensive Care World 5:78–80
Wendon J, Smithies M, Sheppard M, Bullen K, Tinker J, Bihari D (1989) Continuous high volume veno-venous haemofiltration in acute renal failure. Intensive Care Med 15:358–363
Hodson EM, Kjellstrand CM, Mauer SM (1978) Acute renal failure in infants and children: outcome of 53 patients requiring hemodialysis treatment. J Pediatr 93:756–761
Sweet SJ, Glenney CU, FitzGibbon JP, Friedmann P, Teres D (1981) Synergistic effect or acute renal failure and respiratory failure in a surgical intensive care unit. Am J Surg 141:492–496
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zobel, G., Ring, E., Kuttnig, M. et al. Five years experience with continuous extracorporeal renal support in paediatric intensive care. Intensive Care Med 17, 315–319 (1991). https://doi.org/10.1007/BF01716188
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01716188