CVVHD in Pediatrics Multiorgan Dysfunction Syndrome: Bicarbonate-Based Solutions are Feasible and Safe
Bibliographic record
Abstract
OBJECTIVE: To describe continuous veno-venous hemodiafiltration (CVVHD) procedure in a pediatric critical care unit using bicarbonate-based solution. PATIENTS AND METHODS: From 06-2001 to 08-2002, nine patients were treated by CVVHD, age range 1,7–16 yrs, body weight 9,3–45 kg. Indications criteria: oligoanuria and hypevolemia, hemodynamic instability and impossibility of peritoneal dialysis. The patients' primary diseases were: policystic kidney disease (1/9), SLE (1/9), liver disease (6/9), mediastinal germ cells tumos (1/9). All patients were on mechanical ventilation and on vasopressos support. Pancytopenia was diagnosed in 9/9, and hepatic dysfunction in 8/9 pts. The CVVHD prescription was: blood flow rate: 2–4 ml/min, dialisate and replacement flow rate: 2000 ml/1,73m2/h. Systemic heparin anticoagulation could not be used, and citrate regional anticoagulation (4% trissodium citrate) was used in a patient with normal hepatic function. The duration of procedures was 4–72 hours, and the total time range of CVVHD was 28 hours to 19 days. The solution was prepared in our hospital pharmacy. Prisma system (GAMBRO) and poliacrylonitrile M-60 hemofilter was used in all patients. RESULTS: CVVHD was effective to control fluid balance and metabolic derangements. Anaphylactoid reaction was observed in one patient. Six patients died of causes other than renal failure (sepsis in 5/6 pts, hepatic failure in 1/6 pts). Three patients are alive, two with normal renal function. CONCLUSION: CVVHD with bicarbonate-based solutions is feasible and safe and allow metabolic and fluid control in critically ill pediatric patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".