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CVVH in Europe
CVVH in Europe
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All Sorts of Trouble and Complications

• CVVH Experience
• in Hannover
• 7-1997
• to
• 3-2002

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CVVH Machine
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Solutions for Substitution

• SH19 SH39 Hep
• Na 140 145 mmol/l K 1 0 mmol/l Ca 1.63 1.55 mmol/l
  Mg 0.75 0.52 mmol/l Cl 100.75 113.64 mmol/l Lacta
  te 45 - mmol/l Bicarbonate - 36 mmol/l Glucose 1.9
  6 1.04 g/l
• Schiwa

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Patients

• Patients 32
• Male/ Female 18 / 14
• Age years 5.3 (2 days - 19)
• Weight kg 14.1 (3.3 - 88)
• BSA m2 0.63 (0.22 - 1.97)
• median (range)

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Groups of Patients

• Septicemia 12
• Liver failure 9
• Cardiac Disease 5
• Renal Disease 3
• Hyperammonemia 3

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Solutions for Substitution

• Schiwa SH39-Hep N 24
• Schiwa SH 19 8

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Filters Used

• Diafilter 20 20
• Minifilter plus 4
• Minifilter /D20 5
• Hemofilter 6S 3

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Blood and Dialysate Flow

• Blood flow ml/kg/min 3.1 (0.6 - 17.2)
• Exchange rate ml/m2/h 475 (189 -1505)
• Negative balance ml/kg/h 4.2 (0 - 17)

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CAVH Urea
0 1 2 4 8
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Ultrafiltration
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Number Filters Used
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Filters clot
43/140 were lost this way (30.3)
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Duration of CVVH and Filter Survival

• Total duration of CVVH h 56.5 (3 - 422)
• Number of filters 140
• Survival of filter h 22.4 (0.5 - 87)
• Reason for loss deliberate change 44
• of a filter clotting 43
• operation/ CT scan 16
• end of CVVH 27
• technical problems 5
• plasmapheresis 5

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Technical Problems

• Switching between the 2 lines of the access 4
• Necessity to replace access 2
• 3 Lumen oncologic catheter (Clearance 11) 1

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Renal Disease (3/3)
Severe Hypertension during recurrent
HUS 1 Bilateral Nephrectomy during PD in an
infant 1 ATN after renal Tx 1
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Hyperammonemia (1/3)

• All 3 newborns received CVVHD
• Defect CNS involvement Ammonia µmol/l
• Citrullinemia mild encephalopathy 842 ??360
• Citrullinemia severe encephalopathy 802 ??223
• CPS def. cerebral edema 900 ??850

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Heart Disease (1/5)
TGA with Rastelli operation,
bradyarrhythmias 2 Bradyarrhythmias 1 Pulmonary
atresia with interventional opening of the
outflow tract 1 Penetrating heart trauma with a
bicycle 1
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Liver Disease (3/9)

• Liver transplantation (3 acute LF) 7
• Acute liver failure, no TX 2
• Complicating factors
• Re-transplantation 2
• Portal vein thrombosis 2
• CNS symptoms (seizure, edema) 2
• Severe rejection (plasmapheresis) 1
• Destruction of liver and spleen (horse kick) 1

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Septicemia(4/12)

• Bone MarrowTransplant 2
• Oncologic patient 2
• Heart/lungTx in CF, Liver Tx
• Waterhouse-Friedrichsen Sy., Schwachman
• Familial medit. Fever (amyloidosis) SCID
• Premature with NEC Septic RF
• 1 each

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Causes of Death

• Multiple organ failure 8
• Circulatory failure 4
• Brain death 3
• Liver failure 2
• Rhabdomyolysis 2
• Complete bowel necrosis 1

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Major Complications

• Arterial hypotension 15 / 32
• Bleeding 3
• Thrombosis iliac vein 1

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Stenosis of the Internal Jugular Vein
Stenosis of Internal Jugular Vein
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CAVH Results
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Intensive Care and Dialysis

• Total Death
• Cases in intensive care 938 35 4
• LTx 15 (24), NTx 18 (31)
• ICU patients dialysed 24 2.5
• Dialysis 24 9 38
• CVVH 9 4
• PD 14 5
• HD 1 0

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Conclusion

• CVVH broadens the array of treatment options in
  acute renal failure. It allows easier management
  through better fluid and solute clearances.
• However, this does not appreciably improve
  survival. Still, the original disease determines
  the prognosis - with renal failure being an
  negative predictor.