overview crrt in children at two centers in czech republic for 5years (2000 – 2005)
DESCRIPTION
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. Czech republic. 10MILLION INH. CHILDREN 2.5MILLION. - PowerPoint PPT PresentationTRANSCRIPT
ZURICH 4TH PCRRT ZURICH 4TH PCRRT FEBRUARY 2006 FEBRUARY 2006
Overview CRRT in children at two Overview CRRT in children at two centers in Czech republic for 5years centers in Czech republic for 5years
(2000 – 2005)(2000 – 2005)T.Zaoral,M.Hladík, T.Zaoral,M.Hladík,
M.Sádlo, V.VobrubaM.Sádlo, V.Vobruba
PICU, Ped.nephrology, Children´s Hospital OstravaPICU, Ped.nephrology, Children´s Hospital Ostrava
PICU, Children´s Hospital PraguePICU, Children´s Hospital Prague
ZURICH 4TH PCRRT ZURICH 4TH PCRRT FEBRUARY 2006 FEBRUARY 2006
Czech republicCzech republic
• 10MILLION INH.10MILLION INH.
• CHILDREN 2.5MILLIONCHILDREN 2.5MILLION
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• Retrospective data for 5years at 2centers in Czech Retrospective data for 5years at 2centers in Czech republic republic
• Each center follows own institutional practiceEach center follows own institutional practice
- - INITIATION AND TERMINATIONINITIATION AND TERMINATION
- ANTICOAGULATION PROTOCOLS- ANTICOAGULATION PROTOCOLS - MODALITY OF CRRT- MODALITY OF CRRT - FLUIDS - FLUIDS
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Center Census Center Census
0
10
20
30
40
50
60
70
PRAGUE OSTRAVA
Pat
ien
ts n
um
ber
N = 40N = 40 N = 70N = 70
CENTER
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DEMOGRAPHICSDEMOGRAPHICS
• Age 8,8 Age 8,8 ±± 7,6years 7,6years
• Weight 29,2 Weight 29,2 ±± 25,4 kg 25,4 kg
• Gender F 27% M 63%Gender F 27% M 63%
• Total 110 childrenTotal 110 children
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ResultsResults• 142142 patients patients collectedcollected• 110 with complete data110 with complete data• 344 circuits344 circuits single circuit mean time 38 single circuit mean time 38 ±± 21,9hrs (range 6 – 98hrs) 21,9hrs (range 6 – 98hrs)• Mean lenght of CRRT Mean lenght of CRRT == 75hrs 75hrs, median = 88hrs (range 6 – 216hrs =9D), median = 88hrs (range 6 – 216hrs =9D)• Amount of doseAmount of dose (ml/kg/hr) : (ml/kg/hr) : 40kg 67,6% 40kg 67,6% 35ml/kg/hour 35ml/kg/hour 40 – 60kg 36% 40 – 60kg 36% 35ml/kg/hour 35ml/kg/hour 60kg 23% 60kg 23% 35ml/kg/hour 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 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 : failure: a prospective randomise trial : Lancet 2000, Vol.356 Lancet 2000, Vol.356 26-30 26-30
• Frequency of changing set Frequency of changing set : : Ostrava: q. 36hrsOstrava: q. 36hrs Prague : q. 48hrsPrague : q. 48hrs
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ModalityModality
0
10
20
30
40
50
60
CVVH CVVHD CVVHDF CAVHD SCUF
Pat
ient
num
ber
MODALITY
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Vascular accesVascular acces72,7
2012,7
2,7 1,8
0
10
20
30
40
50
60
70
80
V.JUG.INT. V.SUBCL. FEMORALV.
CVC +ARTERY
2 CVC
%
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AnticoagulationAnticoagulation
Anticoagulation CRRT
56%
21%
20% 3%Heparin
LMWH
Citrate
WITHOUT
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Anticoagulation: median life filterAnticoagulation: median life filter
• Heparin 43hrs (range 20–49hrs)Heparin 43hrs (range 20–49hrs)
• LMWH 38hrs (17-46hrs)LMWH 38hrs (17-46hrs)
• Citrate 62hrs (32 –70hrs) one center onlyCitrate 62hrs (32 –70hrs) one center only
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Number of units transfused per Number of units transfused per day of CRRTday of CRRT
HeparinHeparin
n = 61n = 61
Citrate Citrate
n = 22n = 22
pp
Patients trfPatients trf
%%
29 (48%)29 (48%) 8 (27%)8 (27%) << 0,05 0,05
Number ofNumber of
unit trf per unit trf per day CRRTday CRRT
1.0 (0 – 2.0)1.0 (0 – 2.0) 0.3 ( 0 – 0.7)0.3 ( 0 – 0.7) << 0,05 0,05
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Circuit change reasonCircuit change reason
05
10
1520253035
404550
Clotting Accessmalfunction
Machinemalfunction
Procedures(CT)
Delayed solvalarms
%
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PRIMARY DISEASEPRIMARY DISEASE
16
8
6
3 3
16
5
3
10
7
6
8
5 5
4
5
0
2
4
6
8
10
12
14
16
18
Num
ber o
f pts
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REASON TO STARTREASON TO START
38,7
18,7
28,3
8,95,4
0
5
10
15
20
25
30
35
40
45
FOonly(CLS)
EI ONLY FO + EI Prevention ofFO
Other
PA
TIE
NT
S %
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Mortality in children with sepsis +/Mortality in children with sepsis +/ ARF ARF
PRISM 2PRISM 2
ADMISSIONADMISSION
PRISM 2PRISM 2
INITIATION INITIATION CRRTCRRT
MORTALITYMORTALITY
SEPSIS WITHOUT SEPSIS WITHOUT ARFARF
17,8 17,8 ±± 1,2 1,2 21,6 21,6 ±± 2,6 2,6 40%40%
SEPSIS WITH SEPSIS WITH ARFARF
21,4 21,4 ±± 1,6 1,6 23,6 23,6 ±± 1,8 1,8 62%62%
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COMPLETE OUTCOMECOMPLETE OUTCOME
43,6
56,4
0
10
20
30
40
50
60
MORTALITY SURVIVAL
%
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SUBGROUPS MORTALITYSUBGROUPS MORTALITY
43,6 40
6269,2
01020304050607080
TOTAL SEPSIS NO ARF SEPSIS WITHARF
INBORN METABOLIC
%
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Finally our beginningsFinally our beginnings
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