DOI: 10.1097/01.pcc.0000448959.98733.b5

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Issn Print: 1529-7535

Publication Date: 2014/05/01


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ABSTRACT 233: FACTORS AFFECTING CIRCUIT LIFE IN CHILDREN WITH ACUTE LIVER FAILURE (ALF) UNDERGOING CONTINUOUS VENO-VENOUS HAEMOFILTRATION (CVVH)

A. Deep; C. Goonasekera; J. Wang

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Author Information: Paediatric Intensive Care, King’s College Hospital, London, United Kingdom

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Background and aims: Clotting of circuit during CVVH leads to treatment downtimes((time off CVVH whilst new circuit being prepared).In liver failure minimal or no anticoagulation is used during CVVH because of abnormal clotting and increased bleeding risk.But circuits still clot.
Aims: Factors affecting circuit life in children with Acute liver failure on CVVH.
Methods: Prospective review of CVVH circuit life in children with ALF over a 2 year period All children had vascular access via a double lumen catheter. Filter sizes were determined by body weight.Heparin anticoagulation was titrated to ACT of 180–220 seconds.
Results: 31 children in ALF received CVVH (17 male, median age-7.4 years,range 0.01–18). Of these 31 patients with ALF, 17 (54.8%) died. Number of filtration episodes was 98.The smallest double lumen venous access catheter used was 6.5Fr (14%) and largest 13.5 Fr (11%). Commonest filter used was HFO7 (63%). Each filter was used for(median) 22 hours (range 1–126). 52 filters were changed electively. Of the remaining 46, circuit blocked in 25 and access catheter in 13.62 filtration episodes had prostacyclin anticoagulation, 30 had none. Others had either heparin or prostacyclin or both.The median ‘down time’ was 3 hours(Range 0–68). Most children who had circuit failure due to blockage had FFP or RBC within the preceding 2 hours whereas Cryoprecipitate, FFP, RBC or platelet transfusions had been received by most prior to access catheter blockage. Neither duration of CVVH nor ‘down time’ had demonstrable influence on outcome.
Conclusions: CVVH filter circuits fail in children with liver disease despite prolonged clotting. Use of blood products and vascular access catheter related problems seems to reduce filter life despite anticoagulation. Effects of’downtime’ on outcomes need further investigation.

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