Continuous venovenous renal replacement therapy using a conventional infusion pump.

To evaluate continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump in a pediatric sized animal model. Fourteen Maryland pigs weighing 8 to 13 kg were used. A conventional infusion pump (IVAC 571), with a flow of 900 ml/h and a pediatric hemofilter of 0.22 m2 were used. Ringer's solution was used for both the dialysate and the replacement fluid. Each experiment included 1 hour of hemofiltration and 1 hour of hemodiafiltration. Heart rate, arterial blood pressure, pH, Na, K, Cl, and hematocrit were measured every 30 minutes. Mean ultrafiltrate flow was 249.7 +/- 100.3 ml/hr, 240.5 +/- 109.5 ml/hr with hemofiltration and 271 +/- 101.1 ml/hr with hemodiafiltration, the differences not being significant. No significant changes were seen in heart rate, blood pressure, hematocrit, electrolytes, or pH. Pressure in the circuit rose from 107.7 +/- 70.3 mm Hg at the beginning of the experiment to 234.2 +/- 118.1 mm Hg after 2 hours (p < 0.05). The technique was well tolerated by all the pigs. Continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump is a possible alternative to conventional methods of extrarenal replacement therapy in neonates and infants.

[Effect of inhaled nitric oxide on the first 24 hours of assisted respiration in the critically ill child]. / Efecto del óxido nítrico inhalado sobre las primeras 24 horas de asistencia respiratoria en el niño críticamente enfermo.

OBJECTIVE: Our aim was to analyze if inhaled nitric oxide (NO) allows a reduction in respiratory assistance during the first 24 hours of treatment of children with acute respiratory distress syndrome (ARD) and/or pulmonary hypertension (PHT). PATIENTS AND METHODS: We studied 53 children with ARDS and/or PHT refractory to conventional therapy who were treated with inhaled nitric oxide at least 24 hours at 1.5 to 45 ppm. We compared respiratory assistance (peak pressure, PEEP and FiO2) and oxygenation parameters (PaO2/FiO2 ratio and oxygenation index) before and after 6 and 24 hours of treatment. RESULTS: In 45 of 53 children NO improved oxygenation (increase of PaO2/FiO2 > 20%). At six hours of treatment the PaO2/FiO2 ratio increased 31 points, the oxygenation index diminished 4.5 points, and the FiO2 was decreased 11 points without significant changes in peak pressure and PEEP. At 24 hours the PaO2/FiO2 ratio was increased 4 points, the oxygenation index diminished 7.3 points and the FiO2 decreased 18 points in relationship to the initial parameters. CONCLUSIONS: The effect of inhaled nitric oxide on oxygenation remains during the first 24 hours and permits a decrease in the FiO2.