title: Continuous renal replacement therapy results in respiratory and hemodynamic beneficial effects in pediatric patients with severe systemic inflammatory response syndrome and multiorgan system dysfunction.
abstract: BACKGROUND
  Proinflammatory mediators have been implicated in the pathogenesis of systemic inflammatory response syndrome and multiorgan system dysfunction. These mediators are of molecular weights that render them amenable to clearance by the hemodiafiltration mode of continuous renal replacement therapy.
  
  
  OBJECTIVE
  To determine whether a period of 48 hrs of continuous renal replacement therapy in patients with multiorgan system dysfunction secondary to systemic inflammatory response syndrome improves their degree of anasarca as well as their cardiovascular and respiratory systems performances.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Charts of patients diagnosed with systemic inflammatory response syndrome, who were mechanically ventilated in the pediatric intensive care unit and at the same time were receiving continuous renal replacement therapy, from 2004 to 2008, were reviewed. Patients with preexisting renal failure and/or received extracorporeal membrane oxygenation were excluded. Changes in the patients' body weights, oxygenation indices, and vasopressor scores were used as markers for responsiveness to continuous renal replacement therapy. DATA ANALYSIS AND MAIN RESULTS: Data from twenty-two patients with systemic inflammatory response syndrome and with three to five concomitantly diagnosed organ system dysfunctions, at the time continuous renal replacement therapy was initiated, were analyzed. None of the six patients who had five organ system dysfunctions survived to be discharged from the pediatric intensive care unit. Of the remaining 16 patients with three or four organ system dysfunctions, eight (50%) survived and eight (50%) died. The patients' weight, oxygenation indices, and vasopressor scores did not significantly change with 48 hrs of continuous renal replacement therapy.
  
  
  CONCLUSIONS
  Mechanically ventilated patients with systemic inflammatory response syndrome and multiorgan system dysfunction demonstrated a precarious and insignificant response to 48 hrs of continuous renal replacement therapy in a hemodiafiltration mode. However, the patients' overall clinical status did not deteriorate during this therapy. More prospective studies are necessary to determine the effectiveness of continuous renal replacement therapy in patients with multiorgan system dysfunction.
authors.affiliation: Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
authors.forename: Navyn
authors.initials: N
authors.lastname: Naran
authors.forename: Mayer
authors.initials: M
authors.lastname: Sagy
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Bock
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult