Application of continuous renal replacement therapy combined with extracorporeal carbon dioxide removal in children with acute respiratory failure
10.3760/cma.j.issn.1671-0282.2023.06.008
- VernacularTitle:连续性肾脏替代治疗联合体外二氧化碳清除技术在儿童急性呼吸衰竭中的应用体会
- Author:
Wei DANG
1
;
Qin JIANG
;
Yali FU
;
Yanli ZHANG
;
Sufang ZHANG
;
Fan ZHANG
;
Lei LIU
;
Xia LIN
Author Information
1. 济南市儿童医院儿童重症医学科，济南 250022
- Keywords:
Continuous renal replacement therapy;
Extracorporeal carbon dioxide removal;
Respiratory failure;
Children
- From:
Chinese Journal of Emergency Medicine
2023;32(6):761-767
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the role of continuous renal replacement therapy (CRRT) combined with extracorporeal carbon dioxide removal (ECCO 2R) in the treatment of children with respiratory failure. Methods:The clinical data of 12 children with respiratory failure who were treated with CRRT+ECCO 2R in PICU of Jinan Children's Hospital from July 2020 to August 2022 were collected and analyzed retrospectively. The outcomes and the external pipeline usage of the patients were observed, and the blood gas analysis and ventilator parameters before 1 h and after 1, 6, 12 and 24 h of the treatment were compared by one-way ANOVA with LSD post hoc correction. Results:Six patients successfully withdrew from CRRT+ECCO 2R and mechanical ventilation, three patients were transferred to ECMO treatment. Three cases died after voluntary withdrawal of treatment, and two cases died due to treatment failure. The mortality rate was 41.7%. After continuous treatment of CRRT+ECCO 2R for 15 to 112 h, two cases experienced extracorporeal circuit obstruction. After 1 h of treatment, PaCO 2 decreased from (64.67±24.4) mmHg to (49.42±15.54) mmHg, pH increased from (7.28±0.20) to (7.38±0.11), FiO 2 decreased from (0.85±0.13) to (0.78±0.15), PC decreased from (19.42±4.34) cmH 2O to (17.75±4.00) cmH 2O. After 24 h of treatment, PaCO 2 decreased to (39.2±5.55) mmHg, pH increased to (7.41±0.04), FiO 2 decreased to (0.46±0.11), and PC decreased to (13.8±3.36) cmH 2O, and the differences were statistically significant compared with before treatment ( P < 0.05). Conclusions:The combination of CRRT and ECCO 2R therapy can safely substitute for partial lung ventilation/perfusion function, and play a role in protecting right heart function and improving lung-kidney interaction. It can be considered as an option for extracorporeal respiratory, circulatory, and renal support, and consequently has broad prospects.
