title: Novel Use of an Ultrafiltration Device as an Alternative Method for Fluid Removal in Critically Ill Pediatric Patients with Cardiac Disease: A Case Series.
abstract: Fluid overload (FO) is a common complication for pediatric patients in the intensive care unit. When conventional therapy fails, hemodialysis or peritoneal dialysis is classically used for fluid removal. Unfortunately, these therapies are often associated with cardiovascular or respiratory instability. Ultrafiltration, using devices such as the Aquadex™ system (Baxter Healthcare, Deerfield, IL, USA), is an effective tool for fluid removal in adult patients with congestive heart failure. As compared to hemodialysis, ultrafiltration can be performed using smaller catheters, and the extracorporeal volume and minimal blood flow rates are lower. In addition, there is no associated abdominal distension as is seen in peritoneal dialysis. Consequently, ultrafiltration may be better tolerated in critically ill pediatric patients. We present three cases of challenging pediatric patients with FO in the setting of congenital heart disease in whom ultrafiltration using the Aquadex™ system was successfully utilized for fluid removal while cardiorespiratory stability was maintained.
authors.affiliation: Division of Pediatric Cardiology, New York University School of Medicine , NY, USA.
authors.forename: Sujata
authors.initials: S
authors.lastname: Chakravarti
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, New York University School of Medicine , NY, USA.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Al-Qaqaa
authors.affiliation: Division of Pediatric Cardiology, New York University School of Medicine , NY, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Faulkner
authors.affiliation: Division of Pediatric Cardiology, New York University School of Medicine , NY, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Bhatla
authors.affiliation: Division of Pediatric Cardiology, New York University School of Medicine , NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Argilla
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, New York University School of Medicine , NY, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ramirez
keywords: Fluid overload; acute kidney injury; congenital heart disease; ultrafiltration