24 results on '"Bunchman, Timothy"'
Search Results
2. Management of Intoxication via Extracorporeal Therapy in Pediatrics.
- Author
-
Raina R, Sethi SK, and Bunchman T
- Subjects
- Child, Continuous Renal Replacement Therapy, Humans, Renal Replacement Therapy, Extracorporeal Membrane Oxygenation, Pediatrics
- Published
- 2020
- Full Text
- View/download PDF
3. Earthquakes and pediatric nephrology: are we prepared?
- Author
-
Sethi SK, Bunchman T, and Srivastava RN
- Subjects
- Delivery of Health Care, Integrated organization & administration, Haiti, Health Services Accessibility organization & administration, Humans, Triage organization & administration, Civil Defense organization & administration, Disaster Planning organization & administration, Earthquakes, Mass Casualty Incidents, Nephrology organization & administration, Pediatrics organization & administration
- Published
- 2010
- Full Text
- View/download PDF
4. Renal failure and renal replacement therapy.
- Author
-
Maxvold NJ and Bunchman TE
- Subjects
- Acute Kidney Injury etiology, Acute Kidney Injury physiopathology, Anticoagulants therapeutic use, Humans, Nutritional Support, Renal Replacement Therapy instrumentation, Time Factors, Acute Kidney Injury therapy, Pediatrics, Renal Replacement Therapy methods
- Abstract
Continuous renal replacement therapy is an effective means for fluid and solute management in ARF/MOSF. Prospective studies have examined issues of anticoagulation, the impact of replacement/dialysis, the effects of bicarbonate-versus lactate-based solutions, and nutritional and medication clearance. Speculation and bias exists concerning when and for what indications CRRT should be initiated. Many clinicians, supported by data from Ronco and Goldstein, would contest that early institution is better if the risks (eg, access, anticoagulation) are minimal and the possible benefits are maximal. The authors, examining the issues as an intensivist and as a nephrologist, believe that early institution, aggressive replacement/dialysis, and use of citrate-based replacement fluids provide substantive advantages. With the advent of Ronco's recent data on sepsis managed with filtration and plasma absorption, the indication for use of CRRT in MOSF may become more evident regardless of the presence or absence of ARF.
- Published
- 2003
- Full Text
- View/download PDF
5. Concurrent use of continuous kidney replacement therapy during extracorporeal membrane oxygenation: what pediatric nephrologists need to know—PCRRT-ICONIC practice points
- Author
-
Raina, Rupesh, Nair, Nikhil, Pelletier, Jonathan, Nied, Matthew, Whitham, Tarik, Doshi, Kush, Beck, Tara, Dantes, Goeto, Sethi, Sidharth Kumar, Kim, Yap Hui, Bunchman, Timothy, Alhasan, Kahild, Lima, Lisa, Guzzo, Isabella, Fuhrman, Dana, and Paden, Matthew
- Published
- 2024
- Full Text
- View/download PDF
6. Acute kidney injury in pediatric hematopoietic cell transplantation: critical appraisal and consensus
- Author
-
Raina, Rupesh, Abu-Arja, Rolla, Sethi, Sidharth, Dua, Richa, Chakraborty, Ronith, Dibb, James T., Basu, Rajit K., Bissler, John, Felix, Melvin Bonilla, Brophy, Patrick, Bunchman, Timothy, Alhasan, Khalid, Haffner, Dieter, Kim, Yap Hui, Licht, Christopher, McCulloch, Mignon, Menon, Shina, Onder, Ali Mirza, Khooblall, Prajit, Khooblall, Amrit, Polishchuk, Veronika, Rangarajan, Hemalatha, Sultana, Azmeri, and Kashtan, Clifford
- Published
- 2022
- Full Text
- View/download PDF
7. Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.
- Author
-
Sethi, Sidharth Kumar, Luyckx, Valerie, Bunchman, Timothy, Nair, Aishwarya, Bansal, Shyam Bihari, Pember, Bryce, Soni, Kritika, Savita, Yadav, Dinesh Kumar, Sharma, Vivek, Alhasan, Khalid, and Raina, Rupesh
- Subjects
SYNDROMES in children ,DIALYSIS (Chemistry) ,HEMODIALYSIS ,UREMIA ,CHILD patients - Abstract
Background: Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment. Design: Prospective observational quality improvement initiative cohort study. Setting and Participants: A prospective single‐center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023. Quality Improvement Plan: A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%–30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome. Measures: Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long‐term outcomes were assessed at the 1‐year follow‐up including adherence to dialysis, renal transplantation, death, and loss to follow‐up. Results: The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long‐term outcomes showed 88% adherence to dialysis and 38% renal transplantation. Limitations: This study is characterized by a single‐center design, nonrandomized approach, and limited sample size. Conclusions: Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
8. Switching from continuous veno‐venous hemodiafiltration to intermittent sustained low‐efficiency daily hemodiafiltration (SLED‐f) in pediatric acute kidney injury: A prospective cohort study.
- Author
-
Sethi, Sidharth Kumar, Raina, Rupesh, Bansal, Shyam Bihari, Soundararajan, Anvitha, Dhaliwal, Maninder, Raghunathan, Veena, Kalra, Meenal, Soni, Kritika, Mahato, Samit Kumar, Vadhera, Ananya, Yadav, Dinesh Kumar, and Bunchman, Timothy
- Subjects
HEMODIAFILTRATION ,ACUTE kidney failure ,RENAL replacement therapy ,CRITICALLY ill children ,HEPATIC veno-occlusive disease ,PEDIATRIC intensive care ,COHORT analysis - Abstract
Introduction: Continuous kidney replacement therapy (CKRT) is the preferred modality in critically ill children with acute kidney injury. Upon improvement, intermittent hemodialysis is usually initiated as a step‐down therapy, which can be associated with several adverse events. Hybrid therapies such as Sustained low‐efficiency daily dialysis with pre‐filter replacement (SLED‐f) combines the slow sustained features of a continuous treatment, ensuring hemodynamic stability, with similar solute clearance along with the cost effectiveness of conventional intermittent hemodialysis. We examined the feasibility of using SLED‐f as a transition step‐down therapy after CKRT in critically ill pediatric patients with acute kidney injury. Methods: A prospective cohort study was conducted in children admitted to our tertiary care pediatric intensive care units with multi‐organ dysfunction syndrome including acute kidney injury who received CKRT for management. Those patients receiving fewer than two inotropes to maintain perfusion and failed a diuretic challenge were switched to SLED‐f. Results: Eleven patients underwent 105 SLED‐f sessions (mean of 9.55 +/− 4.90 sessions per patient), as a part of step‐down therapy from continuous hemodiafiltration. All (100%) our patients had sepsis associated acute kidney injury with multiorgan dysfunction and required ventilation. During SLED‐f, urea reduction ratio was 64.1 +/− 5.3%, Kt/V was 1.13 +/− 0.1, and beta‐2 microglobulin reduction was 42.5 +/−4%. Incidence of hypotension and requirement of escalation of inotropes during SLED‐f was 18.18%. Filter clotting occurred twice in one patient. Conclusion: SLED‐f is a safe and effective modality for use as a transition therapy between CKRT and intermittent hemodialysis in children in the PICU. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
9. Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy.
- Author
-
Raina, Rupesh, Chakraborty, Ronith, Davenport, Andrew, Brophy, Patrick, Sethi, Sidharth, McCulloch, Mignon, Bunchman, Timothy, and Yap, Hui Kim
- Subjects
THROMBOLYTIC therapy ,THERAPEUTICS ,THROMBOSIS ,ARTIFICIAL blood circulation ,ANTICOAGULANTS ,RENAL replacement therapy ,PEDIATRICS ,PROSTACYCLIN ,HEMODIALYSIS ,HIRUDIN ,ACUTE kidney failure - Abstract
Kidney replacement therapy (KRT) is used to provide supportive therapy for critically ill patients with severe acute kidney injury and various other non-renal indications. Modalities of KRT include continuous KRT (CKRT), intermittent hemodialysis (HD), and sustained low efficiency daily dialysis (SLED). However, circuit clotting is a major complication that has been investigated extensively. Extracorporeal circuit clotting can cause reduction in solute clearances and can cause blood loss, leading to an upsurge in treatment costs and a rise in workload intensity. In this educational review, we discuss the pathophysiology of the clotting cascade within an extracorporeal circuit and the use of various types of anticoagulant methods in various pediatric KRT modalities. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. Management of toxic ingestions with the use of renal replacement therapy
- Author
-
Bunchman, Timothy E. and Ferris, Maria E.
- Published
- 2011
- Full Text
- View/download PDF
11. Rasburicase improves hyperuricemia in infants with acute kidney injury
- Author
-
Hobbs, David J., Steinke, Julia M., Chung, Jin Y., Barletta, Gina-Marie, and Bunchman, Timothy E.
- Published
- 2010
- Full Text
- View/download PDF
12. Renovascular hypertension and intrarenal artery aneurysms in a preschool child
- Author
-
Hobbs, David J., Barletta, Gina-Marie, Mowry, Jeanne A., and Bunchman, Timothy E.
- Published
- 2009
- Full Text
- View/download PDF
13. Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup.
- Author
-
Raina, Rupesh, Grewal, Manpreet K, Blackford, Martha, Symons, Jordan M., Somers, Michael J. G., Licht, Christoph, Basu, Rajit K, Sethi, Sidharth Kumar, Chand, Deepa, Kapur, Gaurav, McCulloch, Mignon, Bagga, Arvind, Krishnappa, Vinod, Yap, Hui-Kim, de Sousa Tavares, Marcelo, Bunchman, Timothy E, Bestic, Michelle, Warady, Bradley A, and de Ferris, Maria Díaz-González
- Subjects
ACETAMINOPHEN ,AMINOGLYCOSIDES ,BARBITURATES ,CARBAMAZEPINE ,INFORMATION storage & retrieval systems ,MEDICAL databases ,MEDICAL information storage & retrieval systems ,KIDNEY diseases ,MEDICAL protocols ,MEDLINE ,METHOTREXATE ,NEPHROTOXICOLOGY ,ONLINE information services ,PEDIATRICS ,PHENYTOIN ,POISONING ,SALICYLATES ,THEOPHYLLINE ,THERAPEUTICS ,VALPROIC acid ,VANCOMYCIN ,SYSTEMATIC reviews ,LITHIUM compounds ,METFORMIN - Abstract
Background: Intentional or unintentional ingestions among children and adolescents are common. There are a number of ingestions amenable to renal replacement therapy (RRT). Methods: We systematically searched PubMed/Medline, Embase, and Cochrane databases for literature regarding drugs/intoxicants and treatment with RRT in pediatric populations. Two experts from the PCRRT (Pediatric Continuous Renal Replacement Therapy) workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and two expert toxicologists, and expert panel recommendations were developed. Results and Conclusions: We have presented the recommendations concerning the use of RRTs for treatment of intoxications with toxic alcohols, lithium, vancomycin, theophylline, barbiturates, metformin, carbamazepine, methotrexate, phenytoin, acetaminophen, salicylates, valproic acid, and aminoglycosides. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
14. Pediatric Nephrology and Rheumatology Practice Patterns in Granulomatosis with Polyangiitis: A Midwest Pediatric Nephrology Consortium Study.
- Author
-
Kaspar, Cristin D. W., Sanderson, Keia, Ozen, Seza, Verghese, Priya S., Lo, Megan, Bunchman, Timothy E., Wenderfer, Scott E., and Kidd, Jason
- Subjects
GLOMERULONEPHRITIS ,RITUXIMAB ,MYCOPHENOLIC acid ,MEDICAL practice ,NEPHROLOGISTS ,NEPHROLOGY ,PEDIATRICS ,RHEUMATOLOGISTS ,RHEUMATOLOGY ,SURVEYS ,VASCULITIS ,TREATMENT duration ,DIAGNOSIS ,THERAPEUTICS - Abstract
Objective. To assess practice pattern similarities and differences amongst pediatric rheumatologists and nephrologists in the management of pediatric Granulomatosis with Polyangiitis (GPA). Methods. A voluntary survey was distributed to the Midwest Pediatric Nephrology Consortium Group (MWPNC) and an international pediatric rheumatology email listserv in 2016-2017. Data were collected on general practice characteristics and preferences for induction management under three clinical scenarios (A-C): newly diagnosed GPA with glomerulonephritis, GPA with rapidly progressive glomerulonephritis, and GPA with pulmonary hemorrhage. In addition, individual preferences for GPA maintenance medications, disease monitoring, and management of GPA with end-stage renal disease were ascertained. Results. There was a 68% response rate from the MWPNC membership and equal numbers of rheumatology respondents. Survey results revealed Rituximab plus Cyclophosphamide is a more common induction choice for rheumatologists than nephrologists in induction Scenarios A and B, whereas Cyclophosphamide is more commonly chosen by nephrologists in Scenario A. Plasmapheresis rates increased for Scenarios A, B, and C for both specialties, but were overall low. There was no clear consensus on the duration of maintenance therapy nor diagnostic work-up. Rheumatologists more frequently chose Rituximab for maintenance and induction compared to nephrologists. There was also a higher than expected proportion of Mycophenolate Mofetil use for both specialties. Conclusion. This survey has revealed important differences in the way that rheumatologists and nephrologists manage this disease. It highlights the need for well-designed clinical trials in pediatric GPA patients and reveals that both specialties must be represented during consensus-building and clinical trial design efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
15. Prolonged intermittent renal replacement therapy in children.
- Author
-
Sinha, Rajiv, Sethi, Sidharth Kumar, Bunchman, Timothy, Lobo, Valentine, and Raina, Rupesh
- Subjects
TREATMENT of acute kidney failure ,BLOOD filtration ,HEMODIALYSIS ,HEMODYNAMICS ,INTENSIVE care units ,KIDNEY diseases ,PEDIATRICS ,PERITONEAL dialysis ,THERAPEUTICS ,TREATMENT duration - Abstract
Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
16. Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities.
- Author
-
Raina, Rupesh, Chauvin, Abigail M., Bunchman, Timothy, Askenazi, David, Deep, Akash, Ensley, Michael J., Krishnappa, Vinod, and Sethi, Sidharth Kumar
- Subjects
TREATMENT of acute kidney failure ,HEMODIALYSIS ,PEDIATRICS ,HEALTH surveys ,CAUSES of death ,DISEASE incidence ,DEVELOPED countries - Abstract
Hypothesis: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability. Methods: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests. Results: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants. Conclusions: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
17. Rapid discontinuation of corticosteroids in pediatric renal transplantation.
- Author
-
Barletta, Gina-Marie, Kirk, Eric, Gardner, John J., Rodriguez, Joshua F., Bursach, Sheri M., and Bunchman, Timothy E.
- Subjects
CORTICOSTEROIDS ,IMMUNOSUPPRESSION ,KIDNEY transplantation ,IMMUNOREGULATION ,PEDIATRICS - Abstract
Corticosteroid immunosuppression has permitted the development of successful allotransplantation; however, corticosteroids are associated significant post-transplant complications. To circumvent these problems, we implemented a protocol of rapid discontinuation of corticosteroids in 19 consecutive pediatric primary kidney transplant recipients. Mean age at time of transplant was 13.4 (±4.5) yr, 52.6% were male, 63.2% underwent living donor transplantation. All patients were administered Thymoglobulin
® [anti-thymocyte globulin (rabbit)] as induction immunosuppression with a rapid tapering dose of corticosteroids (total of five daily doses), and maintained on mycophenolate mofetil and tacrolimus. Two patients had immediate recurrence of primary disease (FSGS), requiring further corticosteroid therapy. Otherwise, remaining 17 patients were maintained off corticosteroids, with excellent graft function; mean baseline eGFR of 112 mL/min/1.73 m2 (±19) at 28 months (±14) post-transplantation. There was 100% patient and rejection-free graft survival at 27 months (range 5–58 months) post-transplantation; 47% underwent renal transplant biopsy secondary to acute rise in serum creatinine with or without worsening hypertension. All biopsies had no evidence of acute rejection; 62.5% had findings consistent with tacrolimus toxicity. Renal transplantation utilizing a rapid discontinuation of corticosteroid protocol in pediatric patients appears to be safe and effective, without increasing the risk of acute rejection or graft loss. [ABSTRACT FROM AUTHOR]- Published
- 2009
- Full Text
- View/download PDF
18. Treatment of acute kidney injury in children: from conservative management to renal replacement therapy.
- Author
-
Bunchman, Timothy E.
- Subjects
- *
KIDNEY injuries , *THERAPEUTICS , *CHILDREN , *MANAGEMENT , *PEDIATRICS - Abstract
Over the past two decades, the etiology and therapy of acute kidney injury (AKI) in children has changed. Historically, hemolytic uremic syndrome was the major cause of pediatric AKI, but advances in technology have meant that sepsis and deterioration of often unrecognized long-term organ dysfunction are now more common causes of pediatric AKI in the developed world. At the same time, major advances in renal replacement therapy in children have occurred as a result of improved strategies for vascular access, more-adaptable equipment, and better techniques and protocols. This Review outlines the etiology, incidence, diagnosis, and treatment--both dialytic and non-dialytic--of pediatric AKI. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
19. Mycophenolate mofetil suspension in pediatric renal transplantation: Three-year data from the tricontinental trial.
- Author
-
Höcker, Britta, Weber, Lutz T., Bunchman, Timothy, Rashford, Michelle, and Tönshoff, Burkhard
- Subjects
KIDNEY transplantation ,PEDIATRICS ,GRAFT rejection prevention ,IMMUNOSUPPRESSIVE agents ,SUSPENSIONS (Chemistry) ,CLINICAL trials - Abstract
Höcker B, Weber LT, Bunchman T, Rashford M, Tönshoff B for the Tricontinental MMF Suspension Study Group. Mycophenolate mofetil suspension in pediatric renal transplantation: Three-year data from the tricontinental trial. Pediatr Transplantation 2005. © 2005 Blackwell Munksgaard Mycophenolate mofetil (MMF) is widely used to prevent acute rejection in adult solid organ transplant recipients, but data in children and adolescents are scarce. This prospective, multicenter, open-labeled, single-arm study investigated the efficacy and safety of an MMF-based immunosuppressive regimen in 100 pediatric renal transplant recipients over a 3-yr period of time. Three age groups were formed (<6 yr, n = 33; 6 to <12 yr, n = 34; 12–18 yr, n = 33). Basic immunosuppression consisted of MMF (600 mg/m
2 b.i.d), cyclosporin A microemulsion and corticosteroids. Seventy-three percent of patients were given anti-lymphocyte antibody induction therapy, of whom 74% received anti-thymocyte globulin. Patient and graft survival 3 yr after transplantation amounted to 98 and 95%, respectively. Twenty-five percent of all patients suffered a biopsy-proven acute rejection episode in the first 6 month post-transplant. Children undergoing induction therapy exhibited a numerically lower rejection rate (21 vs. 37%, p = 0.11). Three years after transplantation, the acute rejection rate added up to 30% (26% with induction therapy vs. 41% without induction therapy, p = 0.21). The number of patients with acute rejection was lowest in the youngest age group (18%), in comparison with 39% in the 6 to <12 yr and 33% in the 12–18 yr age group, respectively. For the entire patient population, the rate of patients who withdrew prematurely because of adverse events was low (12%). The present study shows that MMF therapy in pediatric renal transplant recipients leads to an excellent patient and graft survival 3 yr post-transplant with an acceptable safety profile. [ABSTRACT FROM AUTHOR]- Published
- 2005
- Full Text
- View/download PDF
20. Third International Conference on Pediatric Continuous Renal Replacement Therapy, 24 - 26 June 2004, Orlando, Florida, USA.
- Author
-
Bunchman, Timothy E.
- Subjects
- *
CONFERENCES & conventions , *PEDIATRICS , *KIDNEY diseases , *JUVENILE diseases , *MEDICAL personnel , *MEDICINE - Abstract
The article reports on the Third International Conference on Pediatric Continuous Renal Replacement Therapy (PCRRT), which took place in Orlando, Florida, from 24th to 26th June 2004. Attendees from 13 countries made up an audience that totaled 230 nursing staff, physicians, pharmacists and representatives from industry. The ongoing success of this meeting is due to the energy and interest of clinicians at bedside who wish to improve the outcome in children with acute renal failure and multi organ system failure. The next conference on PCRRT will occur in Zurich, Switzerland.
- Published
- 2005
- Full Text
- View/download PDF
21. The complexity of dialytic therapy in hyperammonemic neonates.
- Author
-
Bunchman, Timothy
- Subjects
- *
METABOLIC disorder treatment , *AMMONIA , *HEMODIALYSIS , *PEDIATRICS , *PERITONEAL dialysis - Abstract
The utilization of renal replacement therapy (RRT) in the setting of hyperammonia is a rare and complicated occurrence. Data demonstrate that the quicker the ammonia level is normalized, the better the neurological outcome. The optimal form of RRT is often decided by local practice. The recent work by Picca and colleagues details a larger series of children who underwent RRT for hyperammonia and adds some credence to the use of peritoneal dialysis (PD) in this population. While these authors conclude that PD is not optimal, they do note that the use of PD may be an option when other forms of RRT are not available. The results reinforce the general maxim that you should continue to do that which you do well and often, which in this context refers to continuing to use your form of RRT until alternative modalities are available. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
22. Pediatric Fulminant Hepatic Failure: Are We Improving Outcome?
- Author
-
Bunchman, Timothy
- Subjects
- *
LIVER failure , *KIDNEY failure , *CONTINUOUS arteriovenous hemofiltration , *BLOOD filtration , *PEDIATRICS , *HEPATIC encephalopathy , *ACUTE diseases - Abstract
The author reflects on pediatric fulminant hepatic failure (FHF). Topics discussed here include, care of renal replacement therapy (RRT) in children with FHF, combination of RRT within the context of continuous RRT (CRRT), and the continuous venovenous hemofiltration (CVVH) and CVVH diffusion (CVVHD).
- Published
- 2016
- Full Text
- View/download PDF
23. Defining Acute Kidney Injury in Children
- Author
-
Sutherland, Scott M., Sethi, Sidharth Kumar, editor, Raina, Rupesh, editor, McCulloch, Mignon, editor, and Bunchman, Timothy E., editor
- Published
- 2021
- Full Text
- View/download PDF
24. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.
- Author
-
Goldstein, Stuart L., Somers, Michael J. G., Baum, Michelle A., Symons, Jordan M., Brophy, Patrick D., Blowey, Douglas, Bunchman, Timothy E., Baker, Cheryl, Mottes, Theresa, McAfee, Nancy, Barnett, Joni, Morrison, Gloria, Rogers, Kristine, and Fortenberry, James D.
- Subjects
- *
KIDNEY transplantation , *JUVENILE diseases , *VENOUS pressure , *KIDNEY diseases , *TRANSPLANTATION of organs, tissues, etc. , *PEDIATRICS - Abstract
Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.Background.Critical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis.Methods.We now report data from the first multicenter study to assess the outcome of pediatric patients with MODS receiving continuous renal replacement therapy (CRRT). One hundred twenty of 157 Registry patients (63 male/57 female) experienced MODS during their course.Results.One hundred sixteen patients had complete data available for analysis. The most common causes leading to CRRT were sepsis (N= 47; 39.2%) and cardiogenic shock (N= 24; 20%). Overall survival was 51.7%. Pediatric Risk of Mortality (PRISM 2) score, central venous pressure (CVP), and% fluid overload (%FO) at CRRT initiation were significantly lower for survivors versus nonsurvivors. Multivariate analysis controlling for severity of illness using PRISM 2 at CRRT initiation revealed that%FO was still significantly lower for survivors versus nonsurvivors (P<0.05) even for patients receiving both mechanical ventilation and vasoactive pressors. We speculate that increased fluid administration from PICU admission to CRRT initiation is an independent risk factor for mortality in pediatric patients with MODS receiving CRRT.Conclusion.We suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.