Abstract
Background EBP has been increasingly used to treat various conditions among critically ill patients and is frequently incorporated into the continuous renal replacement therapy (CRRT) circuit.
Objectives We reported our experience of applying EBP in a newly established Paediatric Intensive Care Unit
Methods The medical records of children requiring EBP in our hospital between 3/2019 to 1/2021 were reviewed
Results Altogether four patients were identified during the period (table 1). No major CRRT-specific complication was encountered except mild electrolytes disturbances.
Patient 1: A 17-year-old girl received high-volume haemodiafiltration as a bridging therapy for her refractory type B lactic acidosis related to the relapse of B-cell acute lymphoblastic leukaemia (ALL). She had a peak lactate level of 18 mmol/L with lowest pH 7.13 and bicarbonate level 6.0 mmol/L. The measured mean lactate clearance was 65 ml/kg/hour.
Patient 2: A 15-year-old male with T-cell ALL had peritonitis and pneumoperitoneum complicated with Klebsiella pneumoniae septicaemia. He required high dose inotropes despite anti-microbials and intravenous immunoglobulin. Two sessions of haemoperfusion using the Oxiris® filter were then performed for endotoxin removal. The inotropes were successfully weaned off afterwards. Resection of the remaining necrotic small bowel was performed 3 days later.
Patient 3: An 8-year-old boy with bone marrow transplantation gradually developed conjugated hyperbilirubinaemia due to acute veno-occlusive disease and graft-versus-host disease. He received a session of single-pass albumin dialysis using 4% albumin as dialysate to reduce his bilirubin level, bridging him to receive a liver biopsy that confirmed his diagnosis. The total bilirubin level decreased from 305 to 222μmol/L after the therapy.
Patient 4: A 14-year-old girl with undiagnosed anaplastic large cell lymphoma was admitted for refractory shock that deteriorated rapidly causing multi-organ failure. She was then started on veno-arterial extracorporeal membrane oxygenation but was complicated with reperfusion injury causing rhabdomyolysis with a peak creatine kinase (CK) level up to 264500IU/L. Myoglobulin clearance using the absorbent Cytosorb® was then added to the CRRT. Her CK level was successfully brought down to 97436IU/ml after 8 hours of therapy. However, she did not respond to the chemotherapy and finally succumbed 5 days after admission.
Conclusions EBP using different techniques and filters can be safely applied in selected children as an adjunctive therapy for various conditions. However, the optimal dose, timing of initiation and monitoring target remain largely unanswered.
