Impact of the first 24h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children.

Abstract

In a group of children admitted to the paediatric intensive care unit (PICU) receiving continuous kidney replacement therapy (CKRT), we aim to evaluate the data about their hemodynamic, ventilation and analgo-sedation profile in the first 24h of treatment and possible associations with mortality. Retrospective cohort study of children admitted to the PICU of the University Hospital of Padova undergoing CKRT between January 2011 and March 2021. Data was collected at baseline (T0), after 1h (T1) and 24h (T24) of CKRT treatment. The differences in outcome measures were compared between these time points, and between survivors and non-survivors. Sixty-nine patients received CKRT, of whom 38 (55%) died during the PICU stay. Overall, the vasoactive inotropic score and the adrenaline dose increased at T1 compared to T0 (p = 0.012 and p = 0.022, respectively). Compared to T0, at T24 patients showed an improvement in the following ventilatory parameters: Oxygenation Index (p = 0.005), Oxygenation Saturation Index (p = 0.013) PaO2/FiO2 ratio (p = 0.005), SpO2/FiO2 ratio (p = 0.002) and Mean Airway Pressure (p = 0.016). These improvements remained significant in survivors (p = 0.01, p = 0.027, p = 0.01 and p = 0.015, respectively) but not in non-survivors. No changes in analgo-sedative drugs have been described. CKRT showed a significant impact on hemodynamics and ventilation in the first 24h of treatment. We observed a significant rise in the inotropic/vasoactive support required after 1h of treatment in the overall population, and an improvement in the ventilation parameters at 24h only in survivors.