Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation
-
Published:2024-09-13
Issue:1
Volume:2
Page:
-
ISSN:2731-944X
-
Container-title:Intensive Care Medicine – Paediatric and Neonatal
-
language:en
-
Short-container-title:Intensive Care Med. Paediatr. Neonatal
Author:
Gist Katja MORCID, Bastero Patricia, Ricci Zaccaria, Kaddourah Ahmad, Strong Amy, Chanchlani Rahul, Steflik Heidi J., Arikan Ayse Akcan, Fuhrman Dana Y, Gelbart Ben, Menon Shina, Beck Tara, Bridges Brian, Lafever Sarah Fernandez, Schmitt Claus Peter, Gorga Stephen M, Salloo Asma, Basu Rajit K, Paden Matthew, Selewski David T
Abstract
AbstractExtracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used primarily for reversible cardiopulmonary failure across the lifespan. Mortality from multiple organ failure on ECMO is high, and unfortunately, complications such as acute kidney injury (AKI) and disorders of fluid balance such as fluid overload (FO) necessitating continuous renal replacement therapy (CRRT) are also common. The largest series of AKI, FO and ECMO related outcomes has been published by the Kidney Interventions During Membrane Oxygenation (KIDMO) multicenter study, which demonstrated patients with AKI and FO have worse outcomes, corroborating with findings from previous single center studies. There are multiple ways to perform CRRT during ECMO, but integration of a CRRT machine in series is the most common approach in neonates and children. The optimal timing of when to initiate CRRT, and how fast to remove fluid during ECMO remain unknown, and there is an urgent need to design studies with these research questions in mind. The disposition and clearance of drugs on ECMO also require urgent study, as drugs metabolism not only is disproportionately affected by the presence of AKI and FO, but also by CRRT prescription and the rate of fluid removal. In this review, we discuss the contemporary epidemiology and outcomes of AKI and FO during ECMO, as well as the use of concurrent CRRT and highlight evidence gaps as a research map.
Publisher
Springer Science and Business Media LLC
Reference65 articles.
1. Guidelines ELSO General Guidelines for all ECLS Cases 2017. In: Editor (ed)^(eds) Book ELSO Guidelines: General Guidelines for all ECLS Cases 2017., City, pp 2. Gadepalli SK, Selewski DT, Drongowski RA, Mychaliska GB (2011) Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J Pediatr Surg 46:630–635 3. Heiss KF, Pettit B, Hirschl RB, Cilley RE, Chapman R, Bartlett RH (1987) Renal insufficiency and volume overload in neonatal ECMO managed by continuous ultrafiltration. ASAIO Trans 33:557–560 4. Swaniker F, Kolla S, Moler F, Custer J, Grams R, Barlett R, Hirschl R (2000) Extracorporeal life support outcome for 128 pediatric patients with respiratory failure. J Pediatr Surg 35:197–202 5. Blijdorp K, Cransberg K, Wildschut ED, Gischler SJ, Jan Houmes R, Wolff ED, Tibboel D (2009) Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study. Crit Care 13:R48
|
|