The International journal of artificial organs
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Children requiring artificial heart-lung support through extracorporeal membrane oxygenation (ECMO) are at increased risk of developing acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is the preferred method of treatment in pediatric AKI patients. CRRT devices are noted to provide inaccurate fluid balance (FB) when operated under low flow rates seen in children. We present the design and validation of a novel pump concept to provide accurate pediatric CRRT during ECMO. ⋯ A novel diaphragm pump concept has been presented for providing CRRT during ECMO in the pediatric population. Improvement of the pump accuracy compared to currently used CRRT pumps was demonstrated via in vitro testing.
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Veno-arterial extracorporeal life support (ECLS) is a well-established bridging therapy in patients with cardiac or pulmonary failure to maintain organ function and is frequently performed in patients who are not intubated. However, severly impaired cardiac function can occur pulmonary edemy in these patients, necessitating left ventricular unloading. ⋯ In this report we present a patient in which the hybrid technique of ECLS with secondary left ventricular unloading was successfully used as a bridge to transplant therapy. This procedure may offer an alternative bridge-to-decision options in selected patients, including those that were not intubated or anaesthetized.
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Observational Study
Continuous veno-venous hemofiltration using a phosphate-containing replacement fluid in the setting of regional citrate anticoagulation.
The need for prolonged anticoagulation and the occurrence of hypophosphatemia are well known drawbacks of continuous renal replacement therapies (CRRT). The aim was to evaluate the effects on acid-base status and serum phosphate of a regional citrate anticoagulation (RCA) protocol for continuous veno-venous hemofiltration (CVVH) combining the use of citrate with a phosphate-containing replacement fluid. ⋯ Although needing further evaluation, the proposed RCA-CVVH protocol ensured a safe and effective RCA without electrolyte and/or acid-base derangements. CRRT-induced hypophosphatemia was prevented in most of the patients by the adoption of a phosphate-containing replacement solution, minimizing phosphate supplementation needs.