Continuous Renal Replacement Therapy In Children With Acute Respiratory Distress Syndrome

Objective:To observe the effects of continuous renal replacement therapy（CRRT）on pulmonary oxygenation function,fluid balance and inflammatory factors in children with acute respiratory distress syndrome（ARDS）,and investigate clinical applications and possible mechanism of CRRT in children with ARDS.Methods:Prospective study included children with ARDS who needed CRRT treatment in the pediatric intensive care unit of children’s intensive care unit of the first affiliated hospital of Hunan Normal University（Hunan Provincial People’s Hospital）from January 2019 to December2019.The mode of CRRT was continuous veno-venous hemo filtration（CVVH）,and we collected the general clinical date of children,blood biochemistry,blood coagulation function,blood gas analysis and fluid overload for 3 days before and after CRRT treatment.We recorded the respiratory mechanical parameters[dynamic lung complianc（Cdyn）,oxygenation index（OI）,Pa O₂/Fi O₂（P/F）]after CRRT treatment.The changes of inflammatory cytokines（IL-8,IL-10,IL-17,TNF-α,TGF-β）were detected by enzyme-linked immunosorbent assay（ELISA）at 0 hour,6 hours,12 hours and 24 hours after CRRT treatment.Results:1.A total of 30 children were included in this study,including 14males and 16 females.The age（M）[interquartile range（IQR）]was 34.50（13.50,45.75）months.Before treatment,the P/F value M（IQR）was107.20（82.75,126.88）mm Hg,they were children with moderate and severe ARDS.2.There was no significant difference in blood routine[white blood cell（WBC）,hemoglobin（HGB）,platelet（PLT）],blood coagulation func tion[activated partial thromboplastin time（APTT）,prothrombin time（PT）,fibrin degradation product（FDP）,D-dimer（DDI）]（P>0.05）,electrolytes[(potassium ion（K⁺）,sodium ion（Na⁺）,chloride ion（Cl^-）,calcium ion(Ca²⁺),magnesium ion(Mg²⁺)before and after CRRT treatment（P>0.05）.Although quantitative fibrinogen（Fbg）decreased after treatment（P<0.05）,it was within the normal range before and after treatment.3.There was no significant change in urea nitrogen（BUN）,creati nine（Cr）,and albumin levels before and after CRRT treatment（P>0.05）,and alanine transaminase（ALT）was lower than that before and after treat ment（P<0.05）.However,both before and after ALT treatment were within the normal range.The aspartate transaminase（AST）and creatine kinase-MB（CK-MB）were significantly lower than that before treatment（P<0.05）.The levels of C-reactive protein（CRP）and procalcitonin（PCT）after CRRT treatment were significantly lower than those before trea tm ent（P<0.05）.4.There was no significant difference in potential of hydrogen（p H）,base excess（BE）and lactate（Lac）levels before and after CRRT treatment（P>0.05）.After treatment,the arterial partial pressure of carbon dioxide（Pa CO₂）gradually decreased,but both before and after treatment were within the normal range.The partial pressure of arterial oxygen（Pa O₂）gradually increased during the treatment,reached the peak at 24hours,then decreased after 48 hours,and slightly increased at 72 hours（P<0.05）.Cdyn began to improve after 6 hours of CRRT treatment,the changes slowed down at 12 hours and improved significantly at 24 hours（P<0.05）.OI value decreased gradually after treatment and the improved significantly after 24 hours（P<0.05）.The value of P/F value began to improve at 12 hours after treatment,decreased at 48 hours,and rose again at 72 hours（P<0.05）.5.After CRRT treatment,the cumulative negative values of fluid overload at 24 hours,48 hours and 72 hours was significantly higher than at 24 hours,48 hours and 72 hours before CRRT treatment,with statistically significant differences（P<0.05）.Fluid overload was assoc iated with prolonged mechanical ventilation.6.The levels of circulating inflammatory cytokines（IL-8,IL-10,IL-17,TNF-α,TGF-β）in the children showed a decreasing trend after CRRT treatment.Among them,the concentration of pro-inflammatory factor IL-8 decreased significantly at 24 hours after treatment（P<0.05）.The concentration of IL-17 was higher before treatment（0 hour）and gradually decreased after treatment,but there was no significant difference（P>0.05）.TNF-αlevels decreased significantly at 24 hours after treatment（P<0.05）.The concentration of anti-inflammatory factor IL-10 decreased after treatment,but the difference was not statistically significant（P>0.05）.TGF-βlevels decreased significantly at 12 hours after treatment（P<0.05）.Conclusion:The application of CRRT in children with moderate and sev ere ARDS can effectively remove inflammatory cytokines,reduce fluid overload and improve pulmonary oxygenation.