Tandem Therapeutic Plasma Exchange Reduces Continuous Renal Replacement Therapy Downtime.
Tandem Therapeutic Plasma Exchange Reduces Continuous Renal Replacement Therapy Downtime.
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DOI：
10.1159/000518348
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发表时间：
2022
影响因子：
3
通讯作者：
Fuhrman DY
中科院分区：
文献类型：
--
作者：
Foglia MJ;Pelletier JH;Bayir H;Fleck A;Konyk L;McSteen C;Fisher D;Fuhrman DY
连续性肾脏替代治疗（CRRT）已成为重症监护室收治的儿童重度急性肾损伤的主要治疗方法。CRRT“停机时间”（回路未激活时）可能占规定治疗时间的很大一部分，并对清除率产生不利影响。本研究的目的是评价与连续性肾脏替代治疗（CRRT）“停机时间”相关的因素，并确定制定串联治疗性血浆置换（TPE）方案是否可以显著和稳健地减少接受两种治疗的患者的回路停机时间。这是一项回顾性队列研究，纳入了2014年1月至2020年7月在匹兹堡UPMC儿童医院儿科、新生儿或心脏ICU接受CRRT的116例患者。我们进行了多变量逻辑回归，以确定与CRRT停机时间相关的因素。我们制定了一项串联TPE方案，使TPE和CRRT可以在2018年4月并行运行而不暂停CRRT。我们通过在运行图上绘制接受CRRT和TPE的患者的停机时间来分析方案变更的影响。通过特殊原因变化评估启动串联TPE对停机时间的影响。对于108/139（77.7%）有可用停机时间数据的会话，停机时间的中位数（IQR）百分比为6.2%（1.7-12.7%）。多变量逻辑回归显示TPE与CRRT停机时间显著相关（p = 0.003），而年龄、性别、种族、导管尺寸和抗凝治疗与此无关。对于接受TPE的患者，在开始串联TPE之前和之后，停机时间的中位数（IQR）百分比分别为14.7%（10.5-26%）和3.4%（1.3-4.9%）（p < 0.001）。停机时间百分比的差异符合特殊原因变化的标准。TPE中断会增加CRRT停机时间。Tandem TPE显著缩短了同时接受两种手术的患者的CRRT停机时间。
Continuous renal replacement therapy (CRRT) has become a primary treatment of severe acute kidney injury in children admitted to the intensive care unit. CRRT “down-time” (when the circuit is not active) can represent a significant portion of the prescribed treatment time and adversely affects clearance. The objective of this study was to evaluate factors associated with continuous renal replacement therapy (CRRT) “down-time” in and to determine whether instituting a tandem therapeutic plasma exchange (TPE) protocol could significantly and robustly decrease circuit down-time in patients receiving both therapies. This is a retrospective cohort study of 116 patients undergoing CRRT in the pediatric, neonatal, or cardiac ICU at UPMC Children’s Hospital of Pittsburgh from January 2014 to July 2020. We performed multivariable logistic regression to determine factors associated with CRRT down-time. We instituted a tandem TPE protocol whereby TPE and CRRT could run in parallel without pausing CRRT in April 2018. We analyzed the effect of the protocol change by plotting down-time for patients undergoing CRRT and TPE on a run chart. The effect of initiating tandem TPE on down-time was assessed by special cause variation. For 108/139 (77.7%) of sessions with down-time data available, the median (IQR) percentage of down-time was 6.2% (1.7–12.7%). Multivariable logistic regression showed that TPE was significantly associated with CRRT down-time (p = 0.003), and that age, sex, race, catheter size, and anticoagulation were not. For patients undergoing TPE, the median (IQR) percentage of down-time was 14.7% (10.5–26%) and 3.4% (1.3–4.9%) before and after initiation of tandem TPE, respectively (p < 0.001). The difference in down-time percentage met criteria for special cause variation. Interruptions for TPE increase CRRT down-time. Tandem TPE significantly reduces CRRT down-time in patients undergoing both procedures concomitantly.
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DOI：
10.1056/nejmoa1611391
发表时间：
2017-01-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
通讯作者：
AWARE Investigators
影响因子：
168.9
作者：
Ronco, C;Bellomo, R;La Greca, G
通讯作者：
La Greca, G
影响因子：
4.1
作者：
Cortina, Gerard;McRae, Rosemary;Butt, Warwick
通讯作者：
Butt, Warwick
影响因子：
4.2
作者：
Zhang, Zhongheng;Ni, Hongying;Lu, Baolong
通讯作者：
Lu, Baolong
影响因子：
4.1
作者：
Symons, Jordan Matthew;McMahon, Marcus Wayne;McMullan, David Michael
通讯作者：
McMullan, David Michael