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RRT in pediatric Heart Surgery : Specific indications. Fluid overload control (unbalance infusion requirements/pt weight) 2) Cytokine Clearance (CPB associated SIRS , post op sepsis) 3) Capillary leak syndrome (extracorporeal surface contact, RAAS/BNP disequilibrium,
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RRT in pediatricHeartSurgery :
Specificindications
RRT in pediatricHeartSurgery :
Specificmodalities
During CPB
NOMENCLATURE
From Chang AC, Hanley FL, Wernovsky G, Wessel DL. Pediatric Cardiac Intensive Care ed W&W 1998
From Chang AC, Hanley FL, Wernovsky G, Wessel DL. Pediatric Cardiac Intensive Care ed W&W 1998
- C3a, C5a, IL-6a, IL-8a, TNF, MDF, ET-1
Davies MJ. J Thorac Cardiovasc Surg 1998
Journois et al, Anesthesiology: Volume 85(5) November 1996 pp 965-976
MEMBRANES (NOT UF) CLEAR MEDIATORS
in CHILDREN UNDERGOING CVVH
Journois et al, Anesthesiology: Volume 85(5) November 1996 pp 965-976
Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery
Kazuto Yokoyama et al JTCVS 2009
Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery
Kazuto Yokoyama et al JTCVS 2009
Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery
Roscitano et al, Asian Cardiovasc Thorac Ann 2009
Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery
Antonino Roscitano, MD, Umberto Benedetto, MD, Massimo Goracci, Fabio Capuano, MD, Remo Lucani, MD1, Riccardo Sinatra, MD
Roscitano et al, Asian Cardiovasc Thorac Ann 2009
Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno–Venous Hemofiltration During Cardiopulmonary Bypass
VAM in thetreatedgroup:
CVVH group 3.55 ± 0.85 h
vs controlgroup 5.8 ± 0.94 h, P < 0.001
ICU STAY:
CVVH group 29.5 ± 6.7 vs. controlgroup 40.5 ± 6.67 h, P < 0.001.
Luciani et al Artif Organs 2009
Anti-inflammatory modalities: Their current use in pediatric cardiac surgery in the United Kingdom and Ireland
Allen et PCCM 2009
“…there are still widespread variations in practice. Rather than reflecting poor clinical practice, we believe this reflects a lack of good evidence supporting clinical benefit”
Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation
Neonates
Children
Askenazi et al PCCM 2010
Courtesy of Norma J Maxvold (modified)
(2 neonates +2 children)
1 neonate and 1 child required pCRRT+ECMO
1 neonate a 1 child required pCRRT alone
Ricci Z, unpublished, 2010
Ricci et al, Blood Purif 2010
Ricci et al, Blood Purif 2010
Age
Weight
Preoperative diagnosis
Presence of ECMO (yes/no)
1
4 days
3.5
HLHS
Y
2
2 years
9
Dilated miocardiopathy
N
3
35 days
4
AoCo+SubAoSt
Y
4
45 days
4.2
TGA with coronary restenosis
Y
5
28 days
3.8
PA with IS
N
6
25 days
3.1
TGA
Y
7
5 days
2.8
HLHS
Y
8
10 days
3.5
HLHS
Y
9
1 year
6
Dilated miocardiopathy
Y
10
2 months
5.2
CAVC
N
Allthatglittersisnotgold
AKI in pediatriccardiacsurgeryisfrequent.
UF during CPB isbeneficial.
Applicationof CRRT toextracorporealcirculatorydevicesispossible.
High expertise, safemachines and trained staff ismandatory.
Dedicatedequipment and prospectivestudies are dramaticallylacking
