Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal rep...

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Veröffentlicht in:	Clinical journal of the American Society of Nephrology Jg. 7; H. 8; S. 1328
Hauptverfasser:	Askenazi, David J, Selewski, David T, Paden, Matthew L, Cooper, David S, Bridges, Brian C, Zappitelli, Michael, Fleming, Geoffrey M
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.08.2012
Schlagworte:	Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Critical Illness Equipment Design Extracorporeal Membrane Oxygenation - adverse effects Extracorporeal Membrane Oxygenation - instrumentation Extracorporeal Membrane Oxygenation - mortality Humans Renal Replacement Therapy - adverse effects Renal Replacement Therapy - instrumentation Renal Replacement Therapy - mortality Risk Assessment Risk Factors Treatment Outcome
ISSN:	1555-905X, 1555-905X
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Abstract	Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population.
AbstractList	Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population. Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population.Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population.
Author	Askenazi, David J Bridges, Brian C Paden, Matthew L Zappitelli, Michael Selewski, David T Cooper, David S Fleming, Geoffrey M
Author_xml	– sequence: 1 givenname: David J surname: Askenazi fullname: Askenazi, David J email: daskenazi@peds.uab.edu organization: Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA. daskenazi@peds.uab.edu – sequence: 2 givenname: David T surname: Selewski fullname: Selewski, David T – sequence: 3 givenname: Matthew L surname: Paden fullname: Paden, Matthew L – sequence: 4 givenname: David S surname: Cooper fullname: Cooper, David S – sequence: 5 givenname: Brian C surname: Bridges fullname: Bridges, Brian C – sequence: 6 givenname: Michael surname: Zappitelli fullname: Zappitelli, Michael – sequence: 7 givenname: Geoffrey M surname: Fleming fullname: Fleming, Geoffrey M
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/22498496$$D View this record in MEDLINE/PubMed
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SubjectTerms	Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Critical Illness Equipment Design Extracorporeal Membrane Oxygenation - adverse effects Extracorporeal Membrane Oxygenation - instrumentation Extracorporeal Membrane Oxygenation - mortality Humans Renal Replacement Therapy - adverse effects Renal Replacement Therapy - instrumentation Renal Replacement Therapy - mortality Risk Assessment Risk Factors Treatment Outcome
Title	Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation
URI	https://www.ncbi.nlm.nih.gov/pubmed/22498496 https://www.proquest.com/docview/1093491704
Volume	7
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