Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplant Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents: Part 2—Focus on Ascites, Fluid and Electrolytes, Renal, and Transfusion Issues

摘要

Highlights ? This report highlights the importance of fluid, electrolyte, and renal dysfunction in the management of veno-occlusive disease (VOD), and gives a time line for renal replacement therapy initiation. ? Strategies for the prevention, diagnosis, and management of fluid overload are discussed. ? The management of peritoneal and pleural effusion, along with abdominal compartment syndrome, is discussed, and strategies to avoid paracentesis-induced circulatory dysfunction are presented. ? Indications for blood and platelets transfusion are presented, along with the role of thromboelastography and rotational thromboelastography TEG/ROTEM in VOD management. ? An approach to treating a patient with VOD and acute bleeding is outlined. Abstract Even though hepatic veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic cell transplantation (HCT), there is paucity of research on the management of associated multiorgan dysfunction. To help provide standardized care for the management of these patients, the HCT Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators and the Supportive Care Committee of the Pediatric Blood and Marrow Transplant Consortium, collaborated to develop evidence-based consensus guidelines. After conducting an extensive literature search, in part 2 of this series we discuss the management of fluids and electrolytes, renal dysfunction; ascites, pleural effusion, and transfusion and coagulopathy issues in patients with VOD. We consider the available evidence using the GRADE criteria.