The presence of acute kidney injury (AKI) and fluid overload can adversely affect outcomes in children with critical illness. Continuous renal replacement therapy (CRRT) is one therapeutic modality that can improve outcomes in these patients. However, the trigger when to initiate this therapy is not known. There are studies suggesting that degree of fluid overload may be such a trigger but this does not seem to provide the entire answer. In adults, some studies have suggested that early initiation of CRRT in critically ill patients can improve outcomes compared to late initiation, although there is a paucity of evidence in children. The authors of this study sought to assess the effect timing of CRRT has on mortality in critically ill children.
Pediatric traumatic brain injury (TBI) remains the leading cause of mortality in children younger than 19 years. Most people think that the secondary brain injury following TBI occurs in the setting of elevated intracranial pressure (ICP) and diminished cerebral perfusion pressure (CPP). These physiologic measurements are thought to affect outcomes, so current guidelines recommend treatment of both elevated ICPs and decreased CPPs, although the thresholds for CPPs have not been well established in children. Although a smaller study looked at CPP in children with TBI, this work by Allen et al is the largest study to date that attempts to determine these thresholds.
Using a prospective, observational cohort, the authors examined data from TBI-trac, an online data repository run by the Brain Trauma Foundation. This databank collects information about patients with severe TBI and uses these data to track guideline compliance at 22 different trauma centers and for research. In this report, the authors reviewed the data on patients treated between 2000 and 2008.
In all, the authors studied 2074 records and divided the patients into categories based on age: 0-5 years (55 patients), 6-11 years (65 patients), 12-17 years (197 patients), and 18 years or older (1757 patients). They subsequently defined high and low CPP thresholds for each age group to determine if these thresholds impacted short-term survival. For those in the youngest group, the authors chose 30 mm Hg for a low CPP threshold (CPP-L) and 40 mm Hg for a high threshold (CPP-H). For subjects in the group 6-11 years, the CPP-L was 35 mm Hg and the CPP-H was 50 mm Hg. For the subjects 12 years or older, the CPP-L selected was 50 mm Hg and the CPP-H was 60 mm Hg. CPP values between the high and low thresholds were labeled as CPP-B.
You are invited to participate in a national survey of clinical practice patterns and awareness of the incidence and outcomes in pediatric acute kidney injury (AKI). The study, being conducted by Amanda Hassinger, MD, at the Women and Children’s Hospital of Buffalo, New York, USA, seeks to elucidate the divide between AKI research and bedside practice.
The survey consists of 25 questions about acute kidney injury and should take no longer than 15 minutes to complete. Participation is voluntary, and you are free to withdraw from this study at any time.
The study has been approved by the Children and Youth Institutional Review Board of the State University of New York at Buffalo. Participation is not associated with any risk as the survey collects no identifying information on the respondent, and all responses will be recorded anonymously. While you will not experience any direct benefits from participation, your input could inform future research and practice guidelines for the detection and management of pediatric acute kidney injury.
If you have any questions regarding the survey or this research project in general, please contact Dr. Hassinger at firstname.lastname@example.org. For questions concerning your rights as a research participant, please contact the Children and Youth Institutional Review Board of the State University of New York at Buffalo (+1 716 878-7141).
By completing and submitting this survey, you are indicating your consent to participate in the study.
Your participation is greatly appreciated. Please click on the link below and complete the survey no later than January 1, 2014.