Impact of continuous renal replacement therapy on oxygenation in children with acute lung injury after allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Acute lung injury (ALI) continues to carry a high mortality rate in children after allogeneic hematopoietic stem cell transplant (HSCT). Continuous renal replacement therapy (CRRT) is often used for these patients for various indications including renal failure and fluid overload, and may have a beneficial effect on oxygenation and survival. Therefore, we sought to determine the effect of CRRT on oxygenation in mechanically ventilated pediatric allogeneic HSCT patients with ALI, and to document survival to intensive care unit discharge in this at-risk population receiving both mechanical ventilation and CRRT.


METHODS
Retrospective analysis of a pediatric allogeneic HSCT cohort admitted to intensive care unit of a single pediatric oncology center from 1994 to 2006 who received CRRT during a course of mechanical ventilation for ALI.


RESULTS
Thirty post-HSCT mechanically ventilated children with ALI who underwent CRRT were included. There was a significant improvement in PaO(2)/FiO(2) with median increase of 31 and 43 in the 24 and 48 hr intervals after initiation of CRRT compared with the 24 hr interval before CRRT (P = 0.0008 and 0.0062, respectively). This improvement in PaO(2)/FiO(2) correlated significantly with reduction of fluid balance achieved after initiation of CRRT (P = 0.0001). There was a trend not reaching statistical significance in improvement in mean airway pressure 48 hr after CRRT in survivors compared to non-survivors.


CONCLUSIONS
CRRT improved oxygenation in mechanically ventilated pediatric allogeneic HSCT patients with ALI.
Elbahlawan
Lama
L
Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA. lama.elbahlawan@stjude.org
West
Nancy K
NK
Avent
Yvonne
Y
Cheng
Cheng
C
Liu
Wei
W
Barfield
Raymond C
RC
Jones
Deborah P
DP
Rajasekaran
Surender
S
Morrison
R Ray
RR
D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood*; D017582:Renal Replacement Therapy / Q000009:adverse effects; D012119:Respiration; D012121:Respiration, Artificial; D014882:Water-Electrolyte Balance
D010100:Oxygen