Special considerations in continuous hemodiafiltration with critically ill pediatric patients

Abstract

Continuous hemodiafiltration (CHDF) has become an essential procedure in critical care. However, effective application of this modality to pediatric patients is associated with several problems derived from their smaller body size and weight compared with adults. We have successfully conducted CHDF in pediatric patients, even newborns, by taking such problems into consideration and navigating around them. Successful CHDF in pediatric patients was achieved by careful and exact execution of the following countermeasures to overcome pediatric-specific problems: minimization of the priming volume; use of colloid solutions or whole blood as priming solution; maintaining secure vascular access; selection of an appropriate anticoagulant; temperature control of both the patient's body and components of the hemofiltration circuit. In pediatric critical care, CHDF is safe and expected to demonstrate clinical efficacy across a wide spectrum of clinical problems, just as in adults.