title: Blood purification in the critically ill patient. Prescription tailored to the indication (including the pediatric patient).
abstract: We maintain a dynamic position on extracorporeal blood purification therapies (EBPT). Continuous therapies are of choice in the hemodynamically unstable patient. We recommend their early introduction in the course of the disease, and starting with a dose of 30-35mL/kg/h. Above all, however, daily re-evaluation is required of the hemodynamic and metabolic situation and water balance of our patients in order to allow dynamic dose adjustment. Some data suggest that continuous EBPT can favorably influence the clinical course of our patients, even in the absence of acute kidney injury. The potential usefulness of hemofiltration at doses higher than the conventional doses (continuous ultrafiltration >50mL/kg/h or pulses of at least 4h a day to more than 100dosesmL/kg/h) for achieving blood purification has also been commented. We review the possible indications of this technique, together with the peculiarities of implementing these therapies in children.
authors.affiliation: Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: jasiruci@gmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Sanchez-Izquierdo Riera
authors.affiliation: Intensive Care Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Montoiro Allué
authors.affiliation: Intensive Care Medicine, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Tomasa Irriguible
authors.affiliation: Intensive Care Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Palencia Herrejón
authors.affiliation: Intensive Care Medicine, Hospital Clínico Virgen de la Victoria, Málaga, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Cota Delgado
authors.affiliation: Intensive Care Medicine, Hospital Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pérez Calvo
mesh_terms: D058186:Acute Kidney Injury; D002648:Child; D016638:Critical Illness; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D014882:Water-Electrolyte Balance
keywords: AKI; Alto volumen; Depuración en pediatría; Depuración extracorpórea; Dose and timing of CEBPT; Dosificación dinámica; Dosis e implementación de las TCDE; Dynamic purification; Extracorporeal purification; FRA; HFAV; HVHF; High volume; Indicaciones no-renales; Non-renal indications; Purification in children