ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
respectively. The prognosis at 28 days
was as follows: alive, 6 patients and
dead, 3 patients. Conclusion: PMX was
safely performed in low-body-weight
children. PMX could elevate their body
pressure and improve their prognosis.
Early induction of PMX might help in
elevating the survival rate of low-bodyweight
children with poor prognosis.
22. Fluid Overload and Fluid Removal
in Pediatric Patients on
Extracorporeal Life Support
Requiring Continuous Renal
Replacement Therapy
David T Selewski, Timothy T Cornell,
Theresa Mottes, Neal B Blatt, Yong H
Han, Mallika Kommareddi, Gail A
Annich, David B Kershaw, Thomas P
Shanley, Michael Heung
Department of Pediatrics &
Communicable Diseases, Division of
Nephrology, C.S. Mott Children's
Hospital, University of Michigan, Ann
Arbor, MI, USA, Department of
Pediatrics & Communicable Diseases,
Division of Critical Care, C.S.
Children's Hospital, University of
Michigan, Ann Arbor, MI, USA,
Department of Internal Medicine,
Division of Nephrology, University of
Michigan, Ann Arbor, MI, USA
Background: Extracorporeal life
support (ECLS) is a life-saving therapy
for pediatric patients with severe cardiac
and respiratory failure. For patients on
ECLS, the development of acute kidney
injury (AKI), including fluid overload
(FO), is associated with increased
mortality. Continuous renal replacement
therapy (CRRT) is frequently used to
manage AKI in these patients, however,
the optimal time to initiate CRRT, and
the role of CRRT to remove fluid
remains undefined. Objective:
Determine the impact of FO at CRRT
initiation and discontinuation on
mortality in pediatric patients
concurrently receiving CRRT and
ECLS. We also examined the kinetics of
CRRT-mediated fluid removal as a
potential predictor of outcomes. We
hypothesized that the ability to remove
fluid and restore fluid balance with
CRRT would be associated with
improved survival. Design/Methods:
Retrospective chart review of all ECLS
patients requiring CRRT <strong>from</strong> July 26 to
September 21. The degree of FO was
determined using ICU admission weight,
weight upon CRRT initiation, daily
weights while on CRRT and weight at
CRRT discontinuation. Results: Overall
ICU survival was 34% for 53 patients
during the study period. Median FO at
CRRT initiation was significantly lower
in survivors compared to non-survivors
(24.5 vs. 38%, p=.6), as was median FO
at CRRT discontinuation (7.1 vs. 17.5%,
p=.35). After adjusting for % FO at
CRRT initiation, age and severity of
illness, the change in FO at CRRT
discontinuation was not significantly
associated with mortality (OR per 1%
decrease in FO was .96, 95% CI .89-
1.3). Further models incorporating the
rate of fluid removal did not find this to
be a significant predictor of mortality.
Conversely, FO at CRRT initiation
remained a significant predictor of
mortality in all models. Conclusions: In
pediatric ECLS patients with AKI
requiring CRRT, FO at CRRT initiation
significantly correlates with increased
mortality, and this relationship appears
to be independent of the ability to
remove fluid while on CRRT. These
results suggest that interventions(such as
CRRT initiation) prior to the
development of significant FO may lead
to better outcomes than attempting fluid
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