Concurrent use of continuous kidney replacement therapy during extracorporeal membrane oxygenation: what pediatric nephrologists need to know—PCRRT-ICONIC practice points.

Autor:	Raina, Rupesh, Nair, Nikhil, Pelletier, Jonathan, Nied, Matthew, Whitham, Tarik, Doshi, Kush, Beck, Tara, Dantes, Goeto, Sethi, Sidharth Kumar, Kim, Yap Hui, Bunchman, Timothy, Alhasan, Kahild, Lima, Lisa, Guzzo, Isabella, Fuhrman, Dana, Paden, Matthew
Předmět:	ADULT respiratory distress syndrome treatment THROMBOSIS prevention TREATMENT of chronic kidney failure INFLAMMATION prevention MEDICAL protocols HYPERVOLEMIA ANTICOAGULANTS RISK assessment EXTRACORPOREAL membrane oxygenation BLOOD filtration HEPARIN HEMODIALYSIS CHRONIC kidney failure THROMBIN CONTINUOUS arteriovenous hemofiltration CLINICAL competence INFLAMMATION PATIENT monitoring CITRATES PLATELET aggregation inhibitors PLASMA exchange (Therapeutics) DISEASE risk factors CHEMICAL inhibitors
Zdroj:	Pediatric Nephrology; Jan2025, Vol. 40 Issue 1, p267-284, 18p
Abstrakt:	Extracorporeal membrane oxygenation (ECMO) provides temporary cardiorespiratory support for neonatal, pediatric, and adult patients when traditional management has failed. This lifesaving therapy has intrinsic risks, including the development of a robust inflammatory response, acute kidney injury (AKI), fluid overload (FO), and blood loss via consumption and coagulopathy. Continuous kidney replacement therapy (CKRT) has been proposed to reduce these side effects by mitigating the host inflammatory response and controlling FO, improving outcomes in patients requiring ECMO. The Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup and the International Collaboration of Nephrologists and Intensivists for Critical Care Children (ICONIC) met to highlight current practice standards for ECMO use within the pediatric population. This review discusses ECMO modalities, the pathophysiology of inflammation during an ECMO run, its adverse effects, various anticoagulation strategies, and the technical aspects and outcomes of implementing CKRT during ECMO in neonatal and pediatric populations. Consensus practice points and guidelines are summarized. ECMO should be utilized in patients with severe acute respiratory failure despite the use of conventional treatment modalities. The Extracorporeal Life Support Organization (ELSO) offers guidelines for ECMO initiation and management while maintaining a clinical registry of over 195,000 patients to assess outcomes and complications. Monitoring and preventing fluid overload during ECMO and CKRT are imperative to reduce mortality risk. Clinical evidence, resources, and experience of the nephrologist and healthcare team should guide the selection of ECMO circuit. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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