当前位置: X-MOL 学术Pediatr. Nephrol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study.
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2020-01-17 , DOI: 10.1007/s00467-019-04468-4
Stephen M Gorga 1 , Rashmi D Sahay 2 , David J Askenazi 3 , Brian C Bridges 4 , David S Cooper 5 , Matthew L Paden 6 , Michael Zappitelli 7 , Katja M Gist 8 , Jason Gien 8 , Rajit K Basu 6 , Jennifer G Jetton 9 , Heidi J Murphy 10 , Eileen King 3, 11 , Geoffrey M Fleming 4 , David T Selewski 10
Affiliation  

OBJECTIVE The aim of this study was to characterize continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to determine the association of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort. METHODS Retrospective chart review of all children < 18 years of age concurrently treated with ECMO and CRRT from January 1, 2007, to December 31, 2011, at six tertiary care children's hospital. Children treated with hemodialysis or peritoneal dialysis were excluded from the FO analysis. MEASUREMENTS AND MAIN RESULTS A total of 756 of the 1009 children supported with ECMO during the study period had complete FO data. Of these, 357 (47.2%) received either CRRT or were treated with an in-line filter and thus entered into the final analysis. Survival to ECMO decannulation was 66.4% and survival to hospital discharge was 44.3%. CRRT initiation occurred at median of 1 day (IQR 0, 2) after ECMO initiation. Median FO at CRRT initiation was 20.1% (IQR 5, 40) and was significantly lower in ECMO survivors vs. non-survivors (15.3% vs. 30.5% p = 0.005) and in hospital survivors vs. non-survivors (13.5% vs. 25.9%, p = 0.004). Median FO at CRRT discontinuation was significantly lower in ECMO survivors (23% vs. 37.6% p = 0.002) and hospital survivors vs. non-survivors (22.6% vs. 36.1%, p = 0.002). In ECMO survivors, after adjusting for pH at CRRT initiation, non-renal complications, ECMO mode, support type, center, patient age and AKI, FO at CRRT initiation (p = 0.01), and FO at CRRT discontinuation (p = 0.0002) were independently associated with duration of ECMO. In a similar multivariable analysis, FO at CRRT initiation (adjusted adds ratio [aOR] 1.09, 95% CI 1.00-1.18, p = 0.045) and at CRRT discontinuation (aOR 1.11, 95% CI 1.03-1.19, p = 0.01) were independently associated with hospital mortality. CONCLUSIONS In a multicenter pediatric ECMO cohort, this study demonstrates that severe FO was very common at CRRT initiation. We found an independent association between the degree of FO at CRRT initiation with adverse outcomes including mortality and increased duration of ECMO support. The results suggest that intervening prior to the development of significant FO may be a clinical therapeutic target and warrants further evaluation.

中文翻译:

接受连续性肾脏替代治疗的体外膜氧合作用的小儿患者的液体超负荷和液体清除:一项多中心回顾性队列研究。

目的本研究的目的是表征在大型多中心连续性肾脏替代疗法(CRRT)在体外膜氧合(ECMO)上的利用,并确定CRRT启动时体液超负荷(FO)和CRRT期间体液清除与死亡率之间的关系。队列。方法回顾性回顾性分析了2007年1月1日至2011年12月31日在六所三级儿童医院中同时接受ECMO和CRRT治疗的所有18岁以下儿童。接受血液透析或腹膜透析治疗的儿童不包括在FO分析中。测量和主要结果在研究期间,在1009名接受ECMO支持的儿童中,共有756名拥有完整的FO数据。其中357(47。2%)接受了CRRT或使用了在线过滤器进行处理,因此进入了最终分析。ECMO放气的生存率为66.4%,出院生存率为44.3%。CRRT启动发生在ECMO启动后的第1天(IQR 0,2)。CRRT开始时的中位FO为20.1%(IQR 5,40),在ECMO幸存者与非幸存者中分别显着降低(15.3%对30.5%p = 0.005),在医院幸存者与非幸存者中(13.5%vs. 25.9%,p = 0.004)。在ECMO幸存者中,CRRT终止时的中位FO明显较低(23%对37.6%,p = 0.002),医院幸存者与非幸存者(22.6%,对36.1%,p = 0.002)。在ECMO幸存者中,在调整CRRT起始时的pH,非肾脏并发症,ECMO模式,支持类型,中心,患者年龄以及CRRT起始时的AKI和FO后(p = 0.01),CRRT停用时的FO和FO(p = 0.0002)与ECMO的持续时间独立相关。在类似的多变量分析中,CRRT启动时的FO(调整后的加和比[aOR] 1.09,95%CI 1.00-1.18,p = 0.045)和CRRT终止时的FO(aOR 1.11,95%CI 1.03-1.19,p = 0.01)为与医院死亡率独立相关。结论在多中心儿科ECMO队列中,这项研究表明,在CRRT开始时严重的FO很常见。我们发现CRRT启动时FO程度与不良后果(包括死亡率)和ECMO支持持续时间增加之间存在独立的关联。结果表明,在显着的FO发生之前进行干预可能是临床治疗目标,需要进一步评估。在类似的多变量分析中,CRRT启动时的FO(调整后的加和比[aOR] 1.09,95%CI 1.00-1.18,p = 0.045)和CRRT终止时的FO(aOR 1.11,95%CI 1.03-1.19,p = 0.01)为与医院死亡率独立相关。结论在多中心儿科ECMO队列中,这项研究表明,严重的FO在CRRT启动时非常常见。我们发现CRRT启动时FO程度与不良后果(包括死亡率)和ECMO支持持续时间增加之间存在独立的关联。结果表明,在显着的FO发生之前进行干预可能是临床治疗目标,值得进一步评估。在类似的多变量分析中,CRRT启动时的FO(调整后的加和比[aOR] 1.09,95%CI 1.00-1.18,p = 0.045)和CRRT终止时的FO(aOR 1.11,95%CI 1.03-1.19,p = 0.01)为与医院死亡率独立相关。结论在多中心儿科ECMO队列中,这项研究表明,严重的FO在CRRT启动时非常常见。我们发现CRRT启动时FO程度与不良后果(包括死亡率)和ECMO支持持续时间增加之间存在独立的关联。结果表明,在显着的FO发生之前进行干预可能是临床治疗目标,值得进一步评估。01)与医院死亡率独立相关。结论在多中心儿科ECMO队列中,这项研究表明,在CRRT开始时严重的FO很常见。我们发现CRRT启动时FO程度与不良后果(包括死亡率)和ECMO支持持续时间增加之间存在独立的关联。结果表明,在显着的FO发生之前进行干预可能是临床治疗目标,值得进一步评估。01)与医院死亡率独立相关。结论在多中心儿科ECMO队列中,这项研究表明,严重的FO在CRRT启动时非常常见。我们发现CRRT启动时FO程度与不良后果(包括死亡率)和ECMO支持持续时间增加之间存在独立的关联。结果表明,在显着的FO发生之前进行干预可能是临床治疗目标,值得进一步评估。
更新日期:2020-04-22
down
wechat
bug