Post on 26-Mar-2015
Hannover
Herrenhausen
New City Hall Kestner Museum
Sprengel MuseumOld City HallIndustrial Fairs
CEBIT
CVVH in EuropeCVVH in Europe
All Sorts of Trouble and Complications
CVVH Experience in Hannover 7-1997
to 3-2002
CVVH Machine
Solutions for Substitution
SH19* SH39 Hep*Na 140 145 mmol/lK 1 0 mmol/lCa 1.63 1.55 mmol/lMg 0.75 0.52 mmol/lCl 100.75 113.64 mmol/lLactate 45 - mmol/lBicarbonate - 36 mmol/lGlucose 1.96 1.04 g/l *Schiwa
Patients
Patients 32
Male/ Female 18 / 14
Age* [years] 5.3 (2 days - 19)
Weight* [kg] 14.1 (3.3 - 88)
BSA [m2] 0.63 (0.22 - 1.97)
*median (range)
Groups of Patients
Septicemia 12
Liver failure 9
Cardiac Disease 5
Renal Disease 3
Hyperammonemia 3
Solutions for Substitution
Schiwa SH39-Hep N 24
Schiwa SH 19 8
Filters Used
Diafilter 20 20
Minifilter plus 4
Minifilter /D20 5
Hemofilter 6S 3
Blood and Dialysate Flow
Blood flow [ml/kg/min] 3.1 (0.6 - 17.2)
Exchange rate [ml/m2/h] 475 (189 -1505)
Negative balance [ml/kg/h] 4.2 (0 - 17)
CAVH Urea
0 1 2 4 8
Ultrafiltration
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 >300
1
2
3
Total Ultrafiltration [ml/min/1.73m ]2
Number Filters Used
1 2 3 4 5 6 7 8 9 10 11 12 13 140
12
3
45
6
78
9
Number of Filters Used
Filters clot
43/140 were lost this way (30.3%)
Duration of CVVH and Filter Survival
Total duration of CVVH [h] 56.5 (3 - 422)Number of filters 140„Survival“ of filter [h] 22.4(0.5 - 87)Reason for loss deliberate change 44of a filter clotting 43
operation/ CT scan 16end of CVVH 27technical problems 5plasmapheresis 5
Technical Problems
Switching between the 2 lines of the access 4
Necessity to replace access 2
3 Lumen oncologic catheter (Clearance 11) 1
Renal Disease (3/3)
Severe Hypertension
during recurrent HUS 1
Bilateral Nephrectomy during PD
in an infant 1
ATN after renal Tx 1
Hyperammonemia (1/3)
All 3 newborns received CVVHD
Defect CNS involvement Ammonia [µmol/l]
Citrullinemia mild encephalopathy 842 360
Citrullinemia severe encephalopathy 802 223
CPS def. cerebral edema 900 850
Heart Disease (1/5)
TGA with Rastelli operation,
bradyarrhythmias 2
Bradyarrhythmias 1
Pulmonary atresia with interventional
opening of the outflow tract 1
Penetrating heart trauma with a bicycle 1
Liver Disease (3/9)
Liver transplantation (3 acute LF) 7
Acute liver failure, no TX 2
Complicating factors
Re-transplantation 2
Portal vein thrombosis 2
CNS symptoms (seizure, edema) 2
Severe rejection (plasmapheresis) 1
Destruction of liver and spleen (horse kick) 1
Septicemia(4/12)
Bone MarrowTransplant 2
Oncologic patient 2
Heart/lungTx in CF, Liver Tx
Waterhouse-Friedrichsen Sy., Schwachman
Familial medit. Fever (amyloidosis) SCID
Premature with NEC Septic RF
1 each
Causes of Death
Multiple organ failure 8
Circulatory failure 4
Brain death 3
Liver failure 2
Rhabdomyolysis 2
Complete bowel necrosis 1
Major Complications
Arterial hypotension 15 / 32
Bleeding 3
Thrombosis iliac vein 1
Stenosis of Internal Jugular VeinStenosis of the Internal Jugular Vein
CAVH Results
Intensive Care and Dialysis
Total Death %
Cases in intensive care 938 35 4
LTx 15 (24), NTx 18 (31)
ICU patients dialysed 24 2.5
Dialysis 24 9 38
CVVH 9 4
PD 14 5
HD 1 0
Conclusion
CVVH broadens the array of treatment options in acute renal failure. It allows easier management through better fluid and solute clearances. However, this does not appreciably improve survival. Still, the original disease determines the prognosis - with renal failure being an negative predictor.