AEIOU strategy for continuous renal replacement therapy in infants <10 kg: a practical and educational framework

TL;DR

The AEIOU strategy is a new framework to help safely and effectively use CRRT in infants under 10 kg, improving care and education.

Contribution

AEIOU is a novel educational and practical framework for CRRT in infants under 10 kg, combining existing knowledge with a structured mnemonic.

Findings

CRRT in infants under 10 kg is challenging due to limited volume and device scarcity.

The AEIOU strategy organizes essential components for CRRT into a structured framework.

AEIOU improves training, quality of care, and outcome monitoring for this vulnerable population.

Abstract

Continuous renal replacement therapy (CRRT) has become a cornerstone in the management of critically ill children with severe acute kidney injury (AKI) and fluid overload. However, its use in neonates and infants weighing less than 10 kg remains particularly challenging due to limited circulating volumes, higher risks of hemodynamic instability, and the scarcity of devices specifically designed for this population. In recent years, new platforms have been introduced, enabling safer extracorporeal support for the smallest patients. Although early experiences suggest that these technologies are feasible and safe, survival outcomes in this fragile group remain suboptimal, and standardized guidelines are still lacking. To address this gap, we propose the AEIOU strategy, an educational and practical framework aimed at organizing and simplifying the essential components required for safe and effective CRRT in infants under 10 kg. AEIOU summarizes: A (Alerts: indications, risks, and contraindications), E (Execution Team), I (Inputs: catheters, machines, filters, and solutions), O (Orders: prescription components such as priming, anticoagulation, blood and effluent flow rates), and U (Unified record: standardized documentation of therapy variables and outcomes). By integrating existing literature with a reproducible mnemonic, AEIOU provides a structured tool for training clinical teams, ensuring quality of care, and laying the foundation for collaborative research. Beyond CRRT, this framework may be adaptable to other extracorporeal therapies in pediatrics. The AEIOU strategy offers a simple yet comprehensive guide to improve implementation, education, and outcome monitoring of CRRT in neonates and small infants.

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