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.