Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support.
OBJECTIVE
Children receiving extracorporeal membrane oxygenation (ECMO) for respiratory failure can have significant fluid overload and renal insufficiency. Addition of inline continuous venovenous hemofiltration (CVVH) could provide additional benefits in fluid management compared to use of standard medical therapies with ECMO.


METHODS
Patients with pediatric respiratory failure receiving ECMO with CVVH were case-matched to similar patients receiving ECMO without CVVH to compare fluid balance, medication use, and clinical outcomes.


RESULTS
Twenty-six of eighty-six patients with pediatric respiratory failure on ECMO (30%) received CVVH for >24 h (median 7.5 days on CVVH). Survival was not significantly different between patients receiving CVVH and those who did not receive CVVH (P = 0.51). For ECMO survivors receiving CVVH, overall fluid balance was less than that in non-CVVH survivors (median 25.1 ml kg(-1) day(-1); range -40.2 to 71.2 vs. 40.2, 1.1 to 134.9; P = 0.028). Time to desired caloric intake was faster in patients receiving CVVH (1 day, 1-5) than in patients who did not receive CVVH (5 days; 1-11; P < 0.001). Patients receiving CVVH-ECMO also received less furosemide (0.67 vs. 2.11 mg kg(-1) day(-1); P = 0.009).


CONCLUSIONS
Use of CVVH in ECMO was associated with improved fluid balance and caloric intake and less diuretics than in case-matched ECMO controls.
Hoover
Nancy G
NG
Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC, USA.
Heard
Michael
M
Reid
Christopher
C
Wagoner
Scott
S
Rogers
Kristine
K
Foland
Jason
J
Paden
Matthew L
ML
Fortenberry
James D
JD
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005440:Fluid Therapy; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D014882:Water-Electrolyte Balance