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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