Use of HF20 membrane in critically ill unstable low-body-weight infants on inotropic support

• Published in: Pediatric nephrology (Berlin, West) West), 2013-05, Vol.28 (5), p.819-822
• Main Authors: Liu, Isaac Desheng, Ng, Kar-Hui, Lau, Perry Yew-Weng, Yeo, Wee-Song, Koh, Pei-Lin, Yap, Hui-Kim
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Anemia; Arterial Pressure - drug effects; Babies; Blood; Body Weight; Brief Report; Cardiomyopathy; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Cardiovascular disease; Care and treatment; Congenital diseases; Critical Illness; Critically ill; Dialysate; Equipment Design; Extracorporeal Membrane Oxygenation; Genetic aspects; Health aspects; Heart surgery; Hemodiafiltration - adverse effects; Hemodiafiltration - instrumentation; Hemodynamics; Hemodynamics - drug effects; Humans; Infant; Intensive care; Intensive Care Units, Pediatric; Kidneys; Medicine; Medicine & Public Health; Membranes, Artificial; Mortality; Multiple Organ Failure - diagnosis; Multiple Organ Failure - physiopathology; Multiple Organ Failure - therapy; Nephrology; Pediatrics; Polymers; Renal replacement therapy; Sepsis; Sulfones; Treatment Outcome; Urology; Venous access
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-012-2394-3

Background Initiating continuous renal replacement therapy (CRRT) in infants exposes them to the dual hemodynamic challenges of high circuit extracorporeal volumes and potential membrane reactions, in the case of acrylonitrile AN69 membranes. The use of the new Prismaflex HF20 membrane in hemodynamically unstable low-body-weight infants on inotropic support has not been reported. Treatment We describe the use of the HF20 (Gambro Lundia AB, Lund, Sweden) membrane in four low-body-weight infants (2.3 to 5.4 kg) with multi-organ dysfunction syndrome who were critically ill in the Pediatric Intensive Care Unit (PICU), hemodynamically unstable, and on inotropes. We were able to achieve target volume loss in all infants without compromising their hemodynamic status. Mean arterial pressures were maintained between 39 and 57 mmHg. The relatively low circuit volume of the HF20 set (60 ml) obviated the need for blood prime in the majority; however, when blood prime was required, there was no adverse reaction with the polyarylethersulfone (PAES) membrane. Solute clearance in these small infants was efficient with correction of metabolic acidosis and electrolyte abnormalities. Excellent circuit lifespan (56.3 ± 32.3 h) was observed. Conclusions CRRT using the HF20 membrane is safe and hemodynamically well tolerated in high-risk, unstable low-body-weight infants with cardiac dysfunction on multiple inotropes.