| Autor: |
Murphy HJ; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA. murphyh@musc.edu.; Division of Neonatology, Medical University of South Carolina, 165 Ashley Avenue, MSC 917, Charleston, South Carolina, 29425, USA. murphyh@musc.edu., Eklund MJ; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA., Hill J; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA., Morella K; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA., Cahill JB; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA., Kiger JR; Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Twombley KE; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA., Annibale DJ; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA. annibald@musc.edu.; Division of Neonatology, Medical University of South Carolina, 165 Ashley Avenue, MSC 917, Charleston, South Carolina, 29425, USA. annibald@musc.edu. |
| Abstrakt: |
Lung opacification on chest radiography (CXR) is common during extracorporeal life support (ECLS), often resulting from pulmonary edema or inflammation. Concurrent use of continuous renal replacement therapy (CRRT) during ECLS is associated with improved fluid balance and cytokine filtration; through modification of these pathologic states, CRRT may modulate lung opacification observed on CXRs. We hypothesize that early CRRT use during infant ECLS decreases lung opacification on CXR. We conducted a retrospective cohort study comparing CXRs from infants receiving ECLS and early CRRT (n = 7) to matched infants who received ECLS alone (n = 7). The CXR obtained prior to ECLS, all CXRs obtained within the first 72 h of ECLS, and daily CXRs for the remainder of the ECLS course were analyzed. The outcome measure was the degree of opacification, determined by independent assessment of two, blinded pediatric radiologists using a modified Edwards et al.'s lung opacification scoring system (from Score 0: no opacification to Score 5: complete opacification). 220 CXRs were assessed (cases: 93, controls: 127). Inter-rater reliability was established (Cohen's weighted к = 0.74; p < 0.0001, good agreement). At baseline, the mean opacification score difference between cases and controls was 1 point (cases: 1.8, controls 2.8; p = 0.049). Using mixed modeling analysis for repeated measures accounting for differences at baseline, the average overall opacification score was 1.2 points lower in cases than controls (cases: 2.1, controls: 3.3; p < 0.0001). The overall distribution of scores was lower in cases than controls. Early CRRT utilization during infant ECLS was associated with decreased lung opacification on CXR. |
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