1068

Abstract

Case Reports: Cumulative fluid overload predicts poor outcomes in critically ill children with acute renal failure. It is often difficult to remove fluid in critically ill infants with renal failure and fluid overload. Slow continuous ultrafiltration (SCUF) is a procedure to remove fluid without removing solutes. This is used to treat fluid overload in adults with congestive heart failure, but has not been widely used in pediatrics. We present two infants in renal failure in whom fluid was successfully removed using SCUF via small central venous catheters. To our knowledge, these are the first two infants for which this has been reported. The first patient was a 3-month-old male with D-transposition of the great arteries who underwent arterial switch procedure complicated by acute renal failure secondary to acute tubular necrosis. A peritoneal dialysis catheter was placed but fluid removal was unsuccessful secondary to significant leakage around the catheter. He had worsening pulmonary edema and was not receiving adequate nutrition. A 5 French 8 centimeter double lumen femoral central venous catheter was placed and SCUF initiated. Over 17 days, 8.1 liters of fluid was removed, ventilator settings were weaned, and enteral feeding was initiated. This patient developed hyponatremia (Na 120mmol/L), a known complication of ultrafiltration. Ultrafiltration was discontinued but was restarted two days later with improved sodium levels. The second patient was a 4-month-old male with autosomal recessive polycystic kidney disease who had inadequate fluid removal via peritoneal dialysis secondary to increased intraabdominal pressure due to hepatomegaly. He had a hemodialysis catheter, but it had to be removed because of infection. He was in respiratory distress, though not requiring ventilatory support, and was more than 20% fluid overloaded. A 5 French 13 centimeter double lumen central venous catheter was placed in the femoral vein for SCUF. Over 23 days, 10.4 liters of fluid was removed from this patient. He remained extubated and feeds were advanced. The major benefits of SCUF in infants are small catheter size and feasibility.