Innovative Techniques to Decrease Blood Exposure and Minimize Interruptions in Pediatric Continuous Renal Replacement Therapy

Eding, Dawn; Jelsma, Lindsey R.; Metz, Caryn J.; Steen, Vanessa S.; Wincek, Jenifer M.

doi:10.4037/ccn2011757

Cited by 16 publications

(20 citation statements)

References 32 publications

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“…The use of RRT in conjunction with other therapies (i.e., plasmapheresis [11], extra-corporeal membrane oxygenation [12], molecular absorbent recirculating systems [13]) is increasingly being implemented across pediatric and adult ICU’s. Future extracorporeal devices show great promise as adjuncts to critical care (e.g.…”

Section: Nephrologist As Leaders For Acute Rrt Programsmentioning

confidence: 99%

Optimal Role of the Nephrologist in the Intensive Care Unit

et al. 2016

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As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.

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Section: Nephrologist As Leaders For Acute Rrt Programsmentioning

confidence: 99%

Optimal Role of the Nephrologist in the Intensive Care Unit

et al. 2016

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“…However, it has some limitations, the most important being a high risk of bleeding and heparin induced thrombocytopenia (HIT). On the other side, citrate anticoagulation in HD, CRRT and also in centrifugal and membrane PE and IA is being increasingly used because of excellent anticoagulation of the blood circuits and the reduced chance of clotting of the extracorporeal system . During HD or CRRT, it is highly recommended to use calcium‐free dialysate.…”

Section: Discussionmentioning

confidence: 99%

Citrate Anticoagulation in Tandem Membrane Plasma‐Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis‐Dependence

2016

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In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line). All tandem procedures were feasible, efficient and safe. No serious side-effects were recorded. The most elegant setup was the procedure with independent, parallel blood circuits. However, serial tandem procedures provided for the elimination of citrate and normalization of electrolytes before blood was returned to the patient.

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“…Many “in tandem” procedures have been described using CRRT, IHD, and/or ECMO in adult populations, and indeed in many pediatric centers it has become common to provide concurrent circuits while on CRRT if clinically indicated . However, the use of IHD with simultaneous TPE in the pediatric population is not well reported at pediatric centers in the United States, albeit described in Canada and Europe .…”

Section: Discussionmentioning

confidence: 99%

In tandem extracorporeal therapies during hemodialysis in pediatric patients

McAlister

Geile

Halabi

et al. 2016

Hemodialysis International

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We describe the successful treatment of a pediatric transplant patient with simultaneous intermittent hemodialysis and therapeutic plasma exchange (TPE). The patient presented with kidney graft failure. He had life threatening electrolyte disturbances and fluid overload due to antibody-mediated rejection. Therefore, he was in need of both emergent kidney replacement therapy and TPE. Both extracorporeal circuits were set up, established, and maintained safely and effectively without difficulty or alarms. Running intermittent hemodialysis and TPE simultaneously significantly reduced therapy time, allowed both needed therapies priority, and provided a superior pediatric patient experience in an acute situation.

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Innovative Techniques to Decrease Blood Exposure and Minimize Interruptions in Pediatric Continuous Renal Replacement Therapy

Cited by 16 publications

References 32 publications

Optimal Role of the Nephrologist in the Intensive Care Unit

Optimal Role of the Nephrologist in the Intensive Care Unit

Citrate Anticoagulation in Tandem Membrane Plasma‐Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis‐Dependence

In tandem extracorporeal therapies during hemodialysis in pediatric patients

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