Development of an Accurate Fluid Management System for a Pediatric Continuous Renal Replacement Therapy Device

• Type of Material: Article
• Authors: Arvind Santhanakrishnan, Georgia Institute of Technology; Trent T. Nestle, Georgia Institute of Technology; Brian L. Moore, Emory University; Ajit Yoganathan, Emory University; Matthew L Paden, Emory University
• Language: English
• Date: 2013-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the American Society for Artificial Internal Organs.
• Final Published Version (URL): http://dx.doi.org/10.1097/MAT.0b013e31828ea5e2
• Title of Journal or Parent Work: ASAIO Journal
• ISSN: 1058-2916
• Volume: 59
• Issue: 3
• Start Page: 294
• End Page: 301
• Grant/Funding Information: This research was supported by an ARRA Challenge Grant; NIDDK -1RC1DK086939, awarded to MLP (Emory University) & APY (Georgia Institute of Technology).
• Keywords: acute kidney injury; PRISMAFLEX HF20; Engineering; ACUTE KIDNEY INJURY; continuous renal replacement therapy; FAILURE; Life Sciences & Biomedicine; Science & Technology; HEMOFILTRATION; CHILDREN; Transplantation; Technology; Engineering, Biomedical; EXTRACORPOREAL MEMBRANE-OXYGENATION; pediatric; SERIES
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

Acute kidney injury is common in critically ill children, and renal replacement therapies provide a life-saving therapy to a subset of these children. However, there is no Food and Drug Administration-approved device to provide pediatric continuous renal replacement therapy (CRRT). Consequently, clinicians adapt approved adult CRRT devices for use in children because of lack of safer alternatives. Complications occur using adult CRRT devices in children because of inaccurate fluid balance (FB) between the volumes of ultrafiltrate (UF) removed and replacement fluid (RF) delivered. We demonstrate the design and validation of a pediatric fluid management system for obtaining accurate instantaneous and cumulative FB. Fluid transport was achieved via multiple novel pulsatile diaphragm pumps. The conservation of volume principle leveraging the physical property of fluid incompressibility along with mechanical coupling via a crankshaft was used for FB. Accuracy testing was conducted in vitro for 8 hour long continuous operation of the coupled UF and RF pumps. The mean cumulative FB error was <1% across filtration flows from 300 to 3000 ml/hour. This approach of FB control in a pediatric-specific CRRT device would represent a significant accuracy improvement over currently used clinical implementations. Copyright