The Effect of Patient- and Treatment-Related Factors on Circuit Lifespan During Continuous Renal Replacement Therapy in Critically Ill Children
The Effect of Patient- and Treatment-Related Factors on Circuit Lifespan During Continuous Renal Replacement Therapy in Critically Ill Children
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DOI：
10.1097/pcc.0000000000002305
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Butt, Warwick
中科院分区：
文献类型：
--
作者：
Cortina, Gerard;McRae, Rosemary;Butt, Warwick
目的：研究患者和治疗变量对需要连续性肾脏替代治疗的危重患儿回路寿命的影响。设计：基于前瞻性注册的回顾性观察性研究。设置：三级转诊30床PICU。患者：在8年期间（2007-2014）接受连续性肾脏替代治疗的161名危重患儿纳入研究。干预措施：连续性肾脏替代治疗。测量和主要结果：在研究期间，161名患者接受了总计22，190小时的连续性肾脏替代治疗，平均持续时间为74.75小时（四分位数范围，32-169.5）。在使用的572个过滤器回路中，276个（48.3%）因回路凝血而更换，262个（45.8%）选择性更换。所有滤器的中位回路寿命为24.62小时（四分位距，10.6-55.3），与因凝血而提前移除的滤器相比，选择性移除的滤器显著更长（35.50小时[四分位距，16.9-67.6] vs 22.00小时[四分位距，13.8-42.5]; p < 0.001）。多元回归分析显示，入院诊断（p < 0.001），抗凝类型（p < 0.001），接入类型（p = 0.016）和电路尺寸（p = 0.027）与回路寿命延长相关，在接受肝素抗凝治疗的患者中，使用更高剂量的肝素（p < 0.001）和活化部分凝血活酶时间延长（p < 0.001）。在这项研究中，儿科连续性肾脏替代治疗的回路寿命较低，似乎取决于患者的诊断，使用的通路类型和抗凝剂以及使用的回路尺寸。
Objectives:To examine the effects of patient and treatment variables on circuit lifespan in critically ill children requiring continuous renal replacement therapy.Design:Retrospective observational study based on a prospective registry.Setting:Tertiary referral 30-bed PICU.Patients:One hundred sixty-one critically ill children undergoing continuous renal replacement therapy during an 8-year period (2007-2014) were included in the study.Interventions:Continuous renal replacement therapy.Measurements and Main Results:During the study period, 161 patients received a total of 22,190 hours of continuous renal replacement therapy, with a median duration of 74.75 hours (interquartile range, 32-169.5) per patient. Of the 572 filter circuits used, 276 (48.3%) were changed due to circuit clotting and 262 (45.8%) were electively changed. Median circuit life was 24.62 hours (interquartile range, 10.6-55.3) for all filters and significantly longer for those electively removed as compared to those prematurely removed because of clotting (35.50 hr [interquartile range, 16.9-67.6] vs 22.00 hr [interquartile range, 13.8-42.5]; p < 0.001). Multivariate regression analyses revealed that admission diagnosis (p < 0.001), anticoagulation type (p < 0.001), access type (p = 0.016), and circuit size (p = 0.027) were associated with prolonged circuit life, as well as, in patients on heparin anticoagulation, with higher doses of heparin (p < 0.001) and a prolonged activated partial thromboplastin time (p < 0.001).Conclusions:In this study, circuit lifespan in pediatric continuous renal replacement therapy was low and appeared to depend upon the patient's diagnosis, the type of access and anticoagulation used as well as the size of the circuit used.