Continuous veno-venous hemofiltration as an adjunctive therapy in children with severe sepsis and septic shock /
إستخدام الغسيل الدموى البطئ المستمر كعلاج مساعد فى الأطفال الذين يعانون من التسمم الحاد و الصدمة الإنتانية
Doaa Meshref Osman ; Supervised Fatina Ibrahim Fadel , Seham Awad Elsherbiny , Ahmed Mohamed Badr
- Cairo : Doaa Meshref Osman , 2017
- 167 P. : charts , facsimiles ; 25cm
Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics
Background and Objectives: The use of continuous renal replacement therapy (CRRT) has been evolving throughout the past years to be used as a multiple organ system support. The efficacy and therapeutic mechanisms of CRRT in improving hemodynamics, oxygenation and all other sepsis complications remains controversial. This study represents the first experience of our pediatric ICU in a resource limited setting, with the use of CRRT in hemodynamically unstable children. Patients and Methods: We conducted a parallel (controlled) interventional study on 41 children weighing 7kg with multiple organ dysfunction syndrome (MODS) secondary to septic shock, admitted at the pediatric Intensive Care Unit of Cairo University Specialized Pediatric Hospital (CUSPH) who were either on high vasopressor support 0.4 æg/kg/min and /or suffered from oliguria < 0.5 ml/kg/min stratified as acute kidney injury (RIFLE- Injury or worse) and /or fluid overload >10% and/or moderate or severe ARDS. Patients on regular hemodialysis or congenital heart diseases were excluded. Patients were divided into two groups, theinterventional group (N=21) who received Pulse high volume hemofiltration (PHVHF) on 60ml/kg/hour for 8 hours followed by conventional dose of Continuous veno -venous hemofiltration (CVVHF) on 35ml/kg/hour for an average total time of 72 hours and a minimum total time of 24 hours. The other group was the control group (N=20)that weremanaged according to our conventional ICU managementof system support. Patients within both groups were assessed at different time intervals: Time zero (T0) which was the time of reaching inclusion criteria and enrollment in the study for the controlgroup and time of initiation of CRRT for the interventional group, 8, 24 and 72 hours after enrollment in study