title: Continuous renal replacement therapy in children with severe sepsis and multiorgan dysfunction - A pilot study on timing of initiation.
abstract: OBJECTIVE
  Scanty literature is available regarding continuous renal replacement therapy (CRRT) utility in severe sepsis with multiorgan dysfunction syndrome (MODS) from developing countries. Author unit's experience in pediatric CRRT is described and outcome of early initiation of CRRT with sepsis and MODS is assessed.
  
  
  METHODS
  Children aged <16 years with sepsis and MODS who required CRRT from September 2010 to February 2015 were analyzed on demographic factors, timing of initiation of CRRT, mode of CRRT, effect of CRRT onhemodynamics, oxygenation parameters, and outcome.
  
  
  RESULTS
  Twenty-seven children required CRRT (male - 16). The median age was 11 years (range 1.1-16). Twenty-one had severe sepsis with MODS. Eighteen patients were given CRRT within 48 h of admission to Intensive Care Unit (ICU). Statistically significant improvement in the P/F ratio, decrement in plateau pressure and vasoactive-inotropic score were noted in survivor group compared to nonsurvivor group (P = 0.022, 0.00, and 0.03, respectively). There was no statistically significant difference in duration of ICU stay, fluid overload, CRRT duration, PRISM score at 12 and 24 h, percentage of decrease in inotrope score, plateau pressure, and percentage of increase in P/F ratio in relation to timing of CRRT initiation. However, the survival rate was 61.1% (11/18) who received CRRT within 48 h of ICU admission compared to 33.3% (3/9) who received after 48 h (P = 0.0001).
  
  
  CONCLUSIONS
  Our study emphasizes the CRRT role in improving the oxygenation status and hemodynamics. Survival benefit may be expected in those children who receive CRRT early in the course of sepsis. However, multicenter RCTs are required to prove mortality benefit.
authors.affiliation: Division of Pediatric Emergency and Critical Care, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Krishna Mohan
authors.initials: KM
authors.lastname: Gulla
authors.affiliation: Division of Pediatric Emergency and Critical Care, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Sachdev
authors.affiliation: Division of Pediatric Emergency and Critical Care, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Dhiren
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Division of Pediatric Emergency and Critical Care, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Division of Pediatric Nephrology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Kanav
authors.initials: K
authors.lastname: Anand
authors.affiliation: Division of Pediatric Nephrology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Pruthi
keywords: Humans; Intensive Care Units; multiple organ failure; pediatrics; renal replacement therapy; sepsis; treatment outcome