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Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children

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Abstract

Background

In a group of children admitted to the paediatric intensive care unit (PICU) receiving continuous kidney replacement therapy (CKRT), we aim to evaluate the data about their hemodynamic, ventilation and analgo-sedation profile in the first 24 h of treatment and possible associations with mortality.

Methods

Retrospective cohort study of children admitted to the PICU of the University Hospital of Padova undergoing CKRT between January 2011 and March 2021. Data was collected at baseline (T0), after 1 h (T1) and 24 h (T24) of CKRT treatment. The differences in outcome measures were compared between these time points, and between survivors and non-survivors.

Results

Sixty-nine patients received CKRT, of whom 38 (55%) died during the PICU stay. Overall, the vasoactive inotropic score and the adrenaline dose increased at T1 compared to T0 (p = 0.012 and p = 0.022, respectively). Compared to T0, at T24 patients showed an improvement in the following ventilatory parameters: Oxygenation Index (p = 0.005), Oxygenation Saturation Index (p = 0.013) PaO2/FiO2 ratio (p = 0.005), SpO2/FiO2 ratio (p = 0.002) and Mean Airway Pressure (p = 0.016). These improvements remained significant in survivors (p = 0.01, p = 0.027, p = 0.01 and p = 0.015, respectively) but not in non-survivors. No changes in analgo-sedative drugs have been described.

Conclusions

CKRT showed a significant impact on hemodynamics and ventilation in the first 24 h of treatment. We observed a significant rise in the inotropic/vasoactive support required after 1 h of treatment in the overall population, and an improvement in the ventilation parameters at 24 h only in survivors.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request.

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Acknowledgements

We thank Nadia Coscini for her help in extensively reviewing the English grammar and syntax throughout the manuscript.

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Authors and Affiliations

  1. Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Simona Imberti & Giovanni Ceschia

  2. Department of Public Health and Pediatrics, University of Turin, Turin, Italy

    Rosanna Comoretto

  3. Pediatric Nephrology, Department of Women’s and Children’s Health, Padua University Hospital, Padua, Italy

    Giovanni Ceschia, Germana Longo & Elisa Benetti

  4. Pediatric Intensive Care Unit, Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Angela Amigoni & Marco Daverio

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  1. Simona Imberti
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Correspondence to Marco Daverio.

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Imberti, S., Comoretto, R., Ceschia, G. et al. Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children. Pediatr Nephrol 39, 879–887 (2024). https://doi.org/10.1007/s00467-023-06155-x

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