The role of continuous venovenous hemofiltration in the nutritional support of critically III children

• p{cyrillic} Objective: To report the impact of continuous venovenous hemofiltration (CVVH) on nutrition delivered to critically ill children. • p{cyrillic} Design: A retrospective, clinical study. • p{cyrillic} Setting: The intensive care unit of a pediatric tertiary care center. • p{cyrillic} Patients: Eleven pediatric patients (mean age, 67.5 ± 17.7 months, range, 2-180 months) who underwent a total of 12 CVVH treatments. • p{cyrillic} Intervention: CVVH and total parenteral nutrition. • p{cyrillic} Main outcome measures: Total fluid, caloric, and protein intakes and patients' weight and serum electrolytes in the 72 hours preceding the initiation of CVVH and again after the first 72 hours of CVVH. • p{cyrillic} Results: The patients received a total of 2,079 hours of treatment (average, 173 ± 30 hours/patient). Total fluid, caloric, and protein intakes in the 72 hours preceding the initiation of CVVH compared with those in the first 72 hours on CVVH significantly increased from 69.7 ± 10.5 mL/kg/d, 33.4 ± 9.0 kcal/kg/d, and 0.73 ± 0.26 g/kg/d, respectively, to 108.1 ± 13.3 mL/kg/d (P < .05), 54.7 ± 9.3 kcal/kg/d (P < .05), and 1.45 ± 0.23 g/kg/d (P < .05), respectively. The average weight was 28.2 ± 9.2 kg before CVVH and remained stable at 28.8 ± 9.2 kg after 72 hours of CVVH (P = not significant). The serum sodium concentrations increased from 133.7 ± 0.8 to 138.3 ± 0.7 mEq/L (P < .05), whereas potassium, chloride, and bicarbonate concentrations remained unchanged. Hypothermia, hemolysis, and bleeding were the few complications. • p{cyrillic} Conclusions: CVVH effectively allows control of fluid balance and metabolic derangement, thus ensuring increased nutrition to the patient. Hence, CVVH is an effective method of continuous renal support for critically ill pediatric patients with multiple organ system failure.