Lessons Learned from a Small Pediatric Continuous Renal Replacement Therapy Program.

Tanya Holt,Amelie Cyr,Laura Wihak,Olivia Griffin,Gregory Hansen,Rebecca Brockman,Jan Hau Lee

doi:10.1155/2021/6481559

Abstract

Continuous renal replacement therapy (CRRT) has become a pillar of care in pediatric intensive care units (PICUs) over the past few decades. Quality indicators (QIs) have been evaluated that reflect safe and accountable CRRT. However, there is a paucity of data on outcomes and QIs in smaller-volume CRRT programming. The purpose of this retrospective study was to evaluate the efficiencies, effectiveness, and outcomes of a small-volume CRRT program. Eighty-two patients received CRRT over a 13-year period, and 79% survived to discharge. Sepsis or nonseptic shock (n = 11 (22%) versus n = 6 (50%); p value = 0.004) and time to CRRT initiation after PICU admission (1.1 versus 5.0 days; p value = 0.005) were independent predictors for mortality. The program also had positive outcomes for QIs related to CRRT efficiency and time of initiation, dosing delivery, and rate of adverse events. This study is important as it illustrates the opportunity that smaller centers have to initiate CRRT programming and provide safe and effective care.

Highlights

Continuous renal replacement therapy (CRRT) has become the mainstay of renal replacement therapy in pediatric intensive care units (PICUs) over the past three decades [1, 2]
Advancements in technology, equipment, and patient carerelated guidelines have resulted in CRRT being the preferred technique to manage critically ill children with acute kidney injury (AKI) and fluid overload [2, 3]
Despite the evolving sophistication of this therapy in the PICU setting, there remains wide practice variation in its application. is is in part related to a dearth of evidence concerning the time of CRRT initiation, dose prescription, optimal mode, and time of discontinuation

Summary

Introduction

Continuous renal replacement therapy (CRRT) has become the mainstay of renal replacement therapy in pediatric intensive care units (PICUs) over the past three decades [1, 2]. A later study found that percentage of volume overload at CRRT initiation was a single indicator associated with worse outcomes [4]. Example indicators included filter life, downtime, time to initiation, dose delivered, and fluid management.

Results

Conclusion