title: High-volume hemofiltration in children with acute liver failure*.
abstract: OBJECTIVE
  High-volume hemofiltration has shown beneficial effects in severe sepsis and multiple organ failure, improving hemodynamics and fluid balance. Recent studies suggest that acute liver failure shares many pathophysiologic similarities with sepsis. Therefore, we assessed the systemic effects of high-volume hemofiltration in children with acute liver failure.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Twenty-two children.
  
  
  METHODS
  Forty-two-bed multidisciplinary pediatric and neonatal ICUs in a tertiary university hospital.
  
  
  METHODS
  We evaluated high-volume hemofiltration therapy as part of standard management of 22 children admitted in our unit for acute liver failure. Fifteen patients had fulminant hepatic failure, three had acute-on-chronic liver disease, and four had primary nonfunction. High-volume hemofiltration was initiated in patients requiring emergency liver transplantation and when hepatic encephalopathy grade higher than 2 and/or hemodynamic instability requiring vasopressors occurred. High-volume hemofiltration was defined by a flow of ultrafiltrate of more than 80 mL/kg/hr. Clinical and biological variables were assessed before and 24 and 48 hours after initiation of high-volume hemofiltration therapy.
  
  
  RESULTS
  High-volume hemofiltration was initiated with a median grade III of hepatic encephalopathy. The median flow of ultrafiltrate was 119 mL/kg/hr (range, 80-384). After 24 hours of high-volume hemofiltration treatment, we observed an increase in mean arterial pressure (p = 0.0002) and a decrease in serum creatinine (p = 0.0002). In half of the patients, the encephalopathy grade decreased. After 48 hours of treatment, mean arterial pressure (p = 0.0005), grade of hepatic encephalopathy (p = 0.04), and serum creatinine (p = 0.0002) improved. Overall mortality was 45.4% (n = 10). Emergency liver transplantation was performed in eight children. Five patients spontaneously recovered liver function.
  
  
  CONCLUSIONS
  High-volume hemofiltration therapy significantly improves hemodynamic stability and neurological status in children with acute liver failure awaiting for emergency liver transplantation.
authors.affiliation: 1Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France. 2Department of Biostatistics, St. Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 3School of Medicine, Paris South University, UPS 11, Le Kremlin-Bicêtre, France. 4Institute of Genetics and Microbiology, School of Sciences, Paris South University, Orsay, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Chevret
authors.forename: Philippe
authors.initials: P
authors.lastname: Durand
authors.forename: Jerome
authors.initials: J
authors.lastname: Lambert
authors.forename: Sandrine
authors.initials: S
authors.lastname: Essouri
authors.forename: Laurent
authors.initials: L
authors.lastname: Balu
authors.forename: Denis
authors.initials: D
authors.lastname: Devictor
authors.forename: Pierre
authors.initials: P
authors.lastname: Tissieres
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome