Author Of 2 Presentations
EFFECT OF CONTINUOUS VENO-VENOUS HEMOFILTRATION ON HEMODYNAMIC STATUS AND OUTCOMES OF CHILDREN WITH FULMINANT MYOCARDITIS
Abstract
Background
Effect of continuous veno-venous hemofiltration (CVVH) on hemodynamic status and outcomes of children with fulminant myocarditis is unknown.
Objectives
This study aimed to assess the effect of CVVH on hemodynamic, metabolic status, and outcome of fulminant myocarditis in children.
Methods
Thirty five children with fulminant myocarditis admitted to PICU of Vietnam National Children's Hospital from 2013 to 2018 were included. Conventional cardiogenic shock management was provided. CVVH was indicated using PrismaFlex machine (Gambro, Germany) with AN69 hemofilter membrane when hemodynamic endpoints of resuscitation protocol were not met and high doses of inotropes- vasopressors were required. Hemodynamic, metabolic parameters, and vasoactive-inotropic score (VIS) were recorded during CVVH. Survival was assessed at 28 days from PICU admission
Results
Median time from ICU admission to therapy initiation was five hours. CVVH duration medians were 69.5 and 46.0 hours for survivors and non-survivors, respectively, and median ultrafiltration rate was 50 ml/kg per hour. After CVVH commenced, mean arterial blood pressure, pH, and central venous oxygen saturation (ScvO2) level increased while heart rate, VIS, and lactate level decreased significantly. Mean heart rate decreased from 174.9 ± 35.0 bpm at initiation to 157.0 ± 27.5 bpm at 12 hours after CVVH. Median VIS decreased from 54.3 at CVVH initiation to 7.5 at 48h after CVVH initiated. Among survivors, fraction ejection of left ventricles improved significantly after 48-72 h of CVVH. Mortality was 31.4%. Time interval from PICU admission to CVVH initiation was associated with survival.
Conclusion
Continuous veno-venous hemofiltration could improve hemodynamic status and outcome of children with fulminant myocarditis
FLUID OVERLOAD IS ASSOCIATED WITH IMPAIRED OXYGENATION AND MORTALITY IN MECHANICALLY VENTILATED CHILDREN
Abstract
Background
Fluid overload (FO) is common in general pediatric intensive care unit (PICU). Information on impact of FO on oxygenation and mortality in ventilated pediatric patients is limited
Objectives
To prospectively evaluate the association between FO and oxygenation, mortality, mechanical ventilation (MV) duration, and length of stay in a PICU.
Methods
From January to August 2018, 245 children aged ≤ 36 months, who were on invasive MV for > 24 h at the PICU of Vietnam National Children's Hospital were included. Demographic and clinical data were recorded. Daily FO was calculated as [(fluid in-fluid out)/admission weight] × 100% in the first 7 days following admission. Univariate and multivariate analysis were used to assess the independent association between FO percent and oxygenation and clinical outcomes.
Results
Median age was 5.5 (IQR 3, 11) months. Peak FO ≥ 10% was present in 20.0%, and FO>15% was present in 9.0% of patients. Peak FO% during the study period correlated significantly with oxygenation index (OI) (r = 0.23, p =.03). Mortality was 29.0%. Fluid overload ≥ 10% was associated with an increased risk of mortality (OR = 3.1, 95% CI 1.5- 6.5, p=.002) after adjusting for age, PELOD score, and disease severity. We observed a dose-response relationship between FO and mortality, as the FO % cutoff percentage increased, odd ratio for mortality significantly increased. FO was associated with MV duration but not with PICU length of stay.
Conclusion
FO was associated with impaired oxygenation, increased risk of mortality, and prolonged duration of MV among survivors in mechanically ventilated children.
Video on Demand
Presenter of 2 Presentations
EFFECT OF CONTINUOUS VENO-VENOUS HEMOFILTRATION ON HEMODYNAMIC STATUS AND OUTCOMES OF CHILDREN WITH FULMINANT MYOCARDITIS
Abstract
Background
Effect of continuous veno-venous hemofiltration (CVVH) on hemodynamic status and outcomes of children with fulminant myocarditis is unknown.
Objectives
This study aimed to assess the effect of CVVH on hemodynamic, metabolic status, and outcome of fulminant myocarditis in children.
Methods
Thirty five children with fulminant myocarditis admitted to PICU of Vietnam National Children's Hospital from 2013 to 2018 were included. Conventional cardiogenic shock management was provided. CVVH was indicated using PrismaFlex machine (Gambro, Germany) with AN69 hemofilter membrane when hemodynamic endpoints of resuscitation protocol were not met and high doses of inotropes- vasopressors were required. Hemodynamic, metabolic parameters, and vasoactive-inotropic score (VIS) were recorded during CVVH. Survival was assessed at 28 days from PICU admission
Results
Median time from ICU admission to therapy initiation was five hours. CVVH duration medians were 69.5 and 46.0 hours for survivors and non-survivors, respectively, and median ultrafiltration rate was 50 ml/kg per hour. After CVVH commenced, mean arterial blood pressure, pH, and central venous oxygen saturation (ScvO2) level increased while heart rate, VIS, and lactate level decreased significantly. Mean heart rate decreased from 174.9 ± 35.0 bpm at initiation to 157.0 ± 27.5 bpm at 12 hours after CVVH. Median VIS decreased from 54.3 at CVVH initiation to 7.5 at 48h after CVVH initiated. Among survivors, fraction ejection of left ventricles improved significantly after 48-72 h of CVVH. Mortality was 31.4%. Time interval from PICU admission to CVVH initiation was associated with survival.
Conclusion
Continuous veno-venous hemofiltration could improve hemodynamic status and outcome of children with fulminant myocarditis
FLUID OVERLOAD IS ASSOCIATED WITH IMPAIRED OXYGENATION AND MORTALITY IN MECHANICALLY VENTILATED CHILDREN
Abstract
Background
Fluid overload (FO) is common in general pediatric intensive care unit (PICU). Information on impact of FO on oxygenation and mortality in ventilated pediatric patients is limited
Objectives
To prospectively evaluate the association between FO and oxygenation, mortality, mechanical ventilation (MV) duration, and length of stay in a PICU.
Methods
From January to August 2018, 245 children aged ≤ 36 months, who were on invasive MV for > 24 h at the PICU of Vietnam National Children's Hospital were included. Demographic and clinical data were recorded. Daily FO was calculated as [(fluid in-fluid out)/admission weight] × 100% in the first 7 days following admission. Univariate and multivariate analysis were used to assess the independent association between FO percent and oxygenation and clinical outcomes.
Results
Median age was 5.5 (IQR 3, 11) months. Peak FO ≥ 10% was present in 20.0%, and FO>15% was present in 9.0% of patients. Peak FO% during the study period correlated significantly with oxygenation index (OI) (r = 0.23, p =.03). Mortality was 29.0%. Fluid overload ≥ 10% was associated with an increased risk of mortality (OR = 3.1, 95% CI 1.5- 6.5, p=.002) after adjusting for age, PELOD score, and disease severity. We observed a dose-response relationship between FO and mortality, as the FO % cutoff percentage increased, odd ratio for mortality significantly increased. FO was associated with MV duration but not with PICU length of stay.
Conclusion
FO was associated with impaired oxygenation, increased risk of mortality, and prolonged duration of MV among survivors in mechanically ventilated children.