Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device.,Pediatric Nephrology

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Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device.
Pediatric Nephrology ( IF 3 ) Pub Date : 2020-05-21 , DOI: 10.1007/s00467-020-04562-y
Francesco Garzotto ₁ , Enrico Vidal ₂ , Zaccaria Ricci ₃ , Fabio Paglialonga ₄ , Mario Giordano ₅ , Nicola Laforgia ₆ , Licia Peruzzi ₇ , Massimo Bellettato ₈ , Luisa Murer ₉ , Claudio Ronco _{10,

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Affiliation

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Division of Pediatrics, Department of Medicine, University Hospital of Udine, University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy.
Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Pediatric Nephrology and Dialysis Unit, Children's Hospital Giovanni XXIII, Bari, Italy.
Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari, Bari, Italy.
Pediatric Nephrology Unit, Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Turin, Italy.
Pediatric Unit, San Bortolo Hospital, Vicenza, Italy.
Nephrology, Dialysis and Transplant Unit, Department of Woman's and Child's Health, University-Hospital of Padova, Padova, Italy.
International Renal Research Institute of Vicenza, Vicenza, Italy.
Department of Nephrology, Dialysis, and Transplantation, San Bortolo Hospital, Vicenza, Italy.
Department of Medicine (DIMED), University of Padova, Padova, Italy.

Background

Providing extracorporeal renal support to neonates and infants involves a number of technical and clinical issues, possibly discouraging early utilization. This report aims to describe a multicenter experience of continuous kidney replacement therapy (CKRT) delivery to small infants using a device specifically designed for this age group.

Methods

A retrospective cohort analysis of all patients treated with the Carpediem™ machine (Bellco-Medtronic, Mirandola, Italy) in 6 centers between June 2013 and December 2016.

Results

Twenty-six neonates and small infants received 165 CKRT sessions in convective modality. Median age at neonatal intensive care unit admission 1 day (IQR 1–11), median body weight 2.9 kg (IQR 2.2–3.6). Median circuit duration 14 h (IQR 10–22), with delivered/prescribed time ratio of 84%. CKRT was conducted using 4 Fr (27%), 5 Fr (35%), 6.5 Fr (11%), and 7 Fr (3%) vascular access, and with umbilical and peripheral accesses (11% each) allowing overall median blood flow of 4.5 ml/kg/min (IQR 3.4–6) and median effluent flow rate 35 ml/kg/h (IQR 28–42). Circuits were primed with normal saline in 58% of treatments, colloids in 31%, and packed red blood cells in 11%. No serious adverse events directly related to machine application were reported by any center. Twenty-five (96%) patients survived their CKRT course and 13 patients (50%) survived to ICU discharge.

Conclusions

CKRT in neonates was easy to initiate and conduct when performed with small central vascular accesses coupled with this device. A dedicated technology for infant CKRT delivery enables patients to be safely treated avoiding technical complications.

中文翻译：

危重新生儿和婴儿的连续肾脏替代治疗：使用专用设备对临床结果进行回顾性分析。

背景

为新生儿和婴儿提供体外肾支持涉及许多技术和临床问题，可能会阻碍早期利用。本报告旨在描述使用专门为该年龄段设计的设备向小婴儿进行连续肾脏替代疗法（CKRT）的多中心体验。

方法

在2013年6月至2016年12月期间，对6个中心的Carpediem™机器（Bellco-Medtronic，Mirandola，意大利）治疗的所有患者进行了回顾性队列分析。

结果

26名新生儿和婴儿接受对流方式的165次CKRT疗程。新生儿重症监护室入院1天的中位数年龄（IQR 1-11），体重中位数2.9 kg（IQR 2.2-3.6）。中值电路持续时间14小时（IQR 10-22），已交付/指定的时间比率为84％。使用4 Fr（27％），5 Fr（35％），6.5 Fr（11％）和7 Fr（3％）的血管通路以及脐带和外周通路（各11％）进行CKRT流量为4.5 ml / kg / min（IQR 3.4–6），中位流量为35 ml / kg / h（IQR 28–42）。在58％的治疗中用生理盐水灌注回路，在31％的过程中用胶体灌注回路，在11％的情况下用红细胞充盈。任何中心均未报告与机器应用直接相关的严重不良事件。