Blood purification therapy for children in critical care in a municipal hospital

Abstract

Blood purification therapy in pediatric critical care was performed for 35 children from December 2007, when instruments were introduced as a center hospital for children, to September 2011. Its methods for children in our hospital have been standardized. A 6Fr catheter was inserted into the right internal jugular vein in neonates under general anesthesia, and a 7Fr catheter in infants to children. In children weighting less than 10kg, a circuit was filled with albumin (neonates: 10% albumin, infants to children: 5% albumin）. In neonates, after starting circuit circulation, rapid blood transfusion was performed with body fluid removal. The blood flow rate (Qb) was established at 25mL/min in neonates and 50mL/min in infants to children. In continuous hemodialysis, the dialysis flow rate (Qd) was established at 500mL/hr for acute renal failure, while it was started at a Qd/Qb ratio of 1.0 for acute liver failure/inborn error of metabolism. In plasmapheresis, 5% albumin or fresh frozen plasma- leukocytes reduced was employed as substitution fluid. The degree of substitution was 80mL/kg. Standardization/simple procedures have facilitated prompt introduction of blood purification therapy in pediatric critical care, and the survival rate of children with blood purification may be improved.