title: Continuous veno-venous hemofiltration may improve survival from acute respiratory distress syndrome after bone marrow transplantation or chemotherapy.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) may result from immunologic activity triggered by irradiation and/or chemotherapy. Hemofiltration removes plasma water and soluble components below 25 kilodaltons. The authors hypothesized that early hemofiltration might attenuate the inflammatory component of ARDS, resulting in increased survival in immunocompromised children and young adults.
  
  
  METHODS
  Ten children (6 bone marrow transplantation, 3 chemotherapy, 1 lymphoma/hemophagocytosis) with ARDS (Pao2/Fio2 94 +/- 37 torr) received early continuous veno-venous hemodiafiltration as adjunctive therapy for respiratory failure, regardless of renal function. Six children had normal urine output and initial serum creatinine (range 0.1-1.2 mg/dL); four had renal insufficiency (initial creatinine 1.7-2.4 mg/dL). Hemofiltration was instituted coincident with intubation. Respiratory failure was precipitated by Enterobacter sepsis in two patients and by Aspergillus in one.
  
  
  RESULTS
  Hemodiafiltration was performed for 13 +/- 9 days. A high rate of clearance was achieved (52 +/- 17 mL/min/1.73 m2). Duration of mechanical ventilation was 14 +/- 9 days. Nine of the 10 children were successfully extubated; 8 survived.
  
  
  CONCLUSIONS
  Early hemofiltration may improve survival from ARDS following bone marrow transplantation or chemotherapy. Possible mechanisms include strict fluid balance, immunomodulation through filtration of inflammatory constituents, and immunomodulation through intensive extracellular water exchange that delivers biochemicals to organs of metabolism as well as the hemofilter.
authors.affiliation: Division of Pediatric Critical Care Medicine, Stanford University Medical School and Lucile Packard Children's Hospital, Palo Alto, California 94304, USA. jdicarlo@stanford.edu
authors.forename: Joseph V
authors.initials: JV
authors.lastname: DiCarlo
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alexander
authors.forename: Rajni
authors.initials: R
authors.lastname: Agarwal
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Schiffman
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate