BACKGROUND: In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk. METHODS: We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range. RESULTS: Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure. CONCLUSIONS: Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
BACKGROUND: In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk. METHODS: We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range. RESULTS: Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure. CONCLUSIONS: Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
Authors: Luca Gabutti; Claudio Marone; Giuseppe Colucci; Francesca Duchini; Carlo Schönholzer Journal: Intensive Care Med Date: 2002-09-06 Impact factor: 17.440
Authors: Jordan M Symons; Annabelle N Chua; Michael J G Somers; Michelle A Baum; Timothy E Bunchman; Mark R Benfield; Patrick D Brophy; Douglas Blowey; James D Fortenberry; Deepa Chand; Francisco X Flores; Richard Hackbarth; Steven R Alexander; John Mahan; Kevin D McBryde; Stuart L Goldstein Journal: Clin J Am Soc Nephrol Date: 2007-05-18 Impact factor: 8.237
Authors: Caroline Schultheiß; Bernd Saugel; Veit Phillip; Philipp Thies; Sebastian Noe; Ulrich Mayr; Bernhard Haller; Henrik Einwächter; Roland M Schmid; Wolfgang Huber Journal: Crit Care Date: 2012-08-22 Impact factor: 9.097
Authors: Keila Rodriguez; Poyyapakkam R Srivaths; Leyat Tal; Mary N Watson; Alyssa A Riley; Ryan W Himes; Moreshwar S Desai; Michael C Braun; Ayse Akcan Arikan Journal: PLoS One Date: 2017-08-08 Impact factor: 3.240