T.Zaoral,M.Hladík, M.Sádlo, V.Vobruba

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Presentation transcript:

Overview CRRT in children at two centers in Czech republic for 5years (2000 – 2005) T.Zaoral,M.Hladík, M.Sádlo, V.Vobruba PICU, Ped.nephrology, Children´s Hospital Ostrava PICU, Children´s Hospital Prague ZURICH 4TH PCRRT FEBRUARY 2006

Czech republic 10MILLION INH. CHILDREN 2.5MILLION ZURICH 4TH PCRRT FEBRUARY 2006

Retrospective data for 5years at 2centers in Czech republic Each center follows own institutional practice - INITIATION AND TERMINATION - ANTICOAGULATION PROTOCOLS - MODALITY OF CRRT - FLUIDS ZURICH 4TH PCRRT FEBRUARY 2006

Center Census N = 40 N = 70 CENTER ZURICH 4TH PCRRT FEBRUARY 2006

DEMOGRAPHICS Age 8,8 ± 7,6years Weight 29,2 ± 25,4 kg Gender F 27% M 63% Total 110 children ZURICH 4TH PCRRT FEBRUARY 2006

Results 142 patients collected 110 with complete data 344 circuits single circuit mean time 38 ± 21,9hrs (range 6 – 98hrs) Mean lenght of CRRT = 75hrs, median = 88hrs (range 6 – 216hrs =9D) Amount of dose (ml/kg/hr) :  40kg 67,6%  35ml/kg/hour 40 – 60kg 36%  35ml/kg/hour  60kg 23%  35ml/kg/hour C.Ronco,R.Bellomo,P.Homel, A.Brendolan et al.: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomise trial : Lancet 2000, Vol.356  26-30 Frequency of changing set : Ostrava: q. 36hrs Prague : q. 48hrs ZURICH 4TH PCRRT FEBRUARY 2006

Modality MODALITY ZURICH 4TH PCRRT FEBRUARY 2006

Vascular acces ZURICH 4TH PCRRT FEBRUARY 2006

Anticoagulation Anticoagulation CRRT 20% 3% 21% Heparin LMWH Citrate WITHOUT 56% ZURICH 4TH PCRRT FEBRUARY 2006

Anticoagulation: median life filter Heparin 43hrs (range 20–49hrs) LMWH 38hrs (17-46hrs) Citrate 62hrs (32 –70hrs) one center only ZURICH 4TH PCRRT FEBRUARY 2006

Number of units transfused per day of CRRT Heparin n = 61 Citrate n = 22 p Patients trf % 29 (48%) 8 (27%) < 0,05 Number of unit trf per day CRRT 1.0 (0 – 2.0) 0.3 ( 0 – 0.7) ZURICH 4TH PCRRT FEBRUARY 2006

Circuit change reason ZURICH 4TH PCRRT FEBRUARY 2006

PRIMARY DISEASE ZURICH 4TH PCRRT FEBRUARY 2006

REASON TO START ZURICH 4TH PCRRT FEBRUARY 2006

Mortality in children with sepsis +/ ARF PRISM 2 ADMISSION INITIATION CRRT MORTALITY SEPSIS WITHOUT ARF 17,8 ± 1,2 21,6 ± 2,6 40% SEPSIS WITH ARF 21,4 ± 1,6 23,6 ± 1,8 62% ZURICH 4TH PCRRT FEBRUARY 2006

COMPLETE OUTCOME ZURICH 4TH PCRRT FEBRUARY 2006

SUBGROUPS MORTALITY ZURICH 4TH PCRRT FEBRUARY 2006

THANK YOU FOR YOUR ATTENTION Oddělení dětské intenzivní a resuscitační péče FAKULTNÍ NEMOCNICE S POLIKLINIKOU OSTRAVA-PORUBA 17.listopadu 1790 Czech republic Email: tomas.zaoral@fnspo.cz Finally our beginnings ZURICH 4TH PCRRT FEBRUARY 2006