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Effect of modified ultrafiltration on pulmonary function after cardiopulmonary bypass
Alaa-Basiouni S Mahmoud1, Mohamed S Burhani, Ali A Hannef
1Division of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Insights
Modified ultrafiltration (MUF) improves lung function immediately after cardiopulmonary bypass (CPB) in pediatric patients. However, these pulmonary benefits are temporary and do not affect extubation or hospital stay duration.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiopulmonary Bypass
- Respiratory Physiology
Background:
- Pulmonary dysfunction is a common complication following cardiopulmonary bypass (CPB).
- Inflammatory responses post-CPB significantly impact lung function in pediatric patients undergoing congenital heart defect repair.
Purpose of the Study:
- To evaluate the efficacy of a modified ultrafiltration (MUF) technique in mitigating pulmonary dysfunction after CPB in children.
- To assess the impact of MUF on lung compliance and gas exchange capacity post-cardiac surgery.
Main Methods:
- A prospective randomized study involving 40 pediatric patients (5-10 kg) with congenital heart disease undergoing biventricular repair.
- Patients were randomized to receive either conventional ultrafiltration (CUF) or CUF plus modified ultrafiltration (MUF) during CPB.
- Pulmonary compliance and gas exchange parameters were measured at multiple time points, including baseline, post-CPB, and post-MUF.
Main Results:
- Cardiopulmonary bypass significantly reduced lung compliance and gas exchange in both groups.
- Modified ultrafiltration (MUF) demonstrated an immediate, significant improvement in static and dynamic lung compliance and gas exchange capacity.
- These pulmonary improvements following MUF were not sustained beyond 6 hours postoperatively.
Conclusions:
- Modified ultrafiltration (MUF) offers transient benefits for lung function immediately after cardiopulmonary bypass in pediatric cardiac surgery.
- The temporary improvements in lung compliance and gas exchange do not translate to reduced extubation times or shorter hospital stays.
- MUF may help minimize immediate pulmonary dysfunction, but its long-term impact on recovery outcomes requires further investigation.
Background:
Pulmonary dysfunction is one of the most common manifestations of inflammatory response after cardiopulmonary bypass (CPB).
Objective:
This prospective randomized study was conducted to evaluate the effect of a modified ultrafiltration (MUF) technique on pulmonary function after CPB in children.
Methods:
Forty patients weighing from 5 to 10 kg with congenital heart disease who required CPB for primary biventricular operative repair were prospectively randomized into two groups. The control group received conventional ultrafiltration (CUF) during CPB, and the study group received CUF and MUF. Pulmonary compliance (static and dynamic) and gas exchange capacity of the lung expressed as oxygen index, respiratory index, ventilation index, and alveolar-arterial oxygen pressure difference were measured after intubation (baseline), at the termination of CPB, at the end of MUF, on admission to the ICU, and 6 h postoperatively.
Results:
There was no significant difference in lung compliance and gas exchange between the two groups before CPB. CPB produced a significant decrease in static and dynamic lung compliance in both groups. In the control group, static and dynamic lung compliance decreased from 1.0 +/- 0.3 to 0.90 +/- 0.3 mL/cm/kg and 0.87 +/- 0.2 to 0.71 +/- 0.1 mL/cm/kg (+/- SE) [p = 0.0002 and p = 0.002, respectively]. In the study group, static and dynamic lung compliance decreased from 1.0 +/- 0.2 to 0.89 +/- 0.03 mL/cm/kg and 0.94 +/- 0.2 to 0.77 +/- 0.1 mL/cm/kg (p = 0.002 and p = 0.002, respectively). There was no significant difference in the decrease in static (p = 0.9) or dynamic lung compliance (p = 0.3) between the two groups. MUF produced a significant immediate improvement in both static lung compliance (0.89 +/- 0.2 to 0.98 +/- 0.2 mL/cm/kg, p = 0.03) and dynamic lung compliance (0.77 +/- 0.1 to 0.93 +/- 0.2 mL/cm/kg, p = 0.007). The same was observed regarding the gas exchange capacity. CPB produced a significant decrease in lung gas exchange capacity, and MUF produced a significant immediate improvement in lung gas exchange capacity. The effect of MUF on lung compliance and gas exchange capacity was not sustained after admission to the ICU nor 6 h later postoperatively. There was no significant difference in the time of extubation between the two groups (12 +/- 3 h and 13 +/- 2 h, p = 0.4), the length of ICU stay, or the total hospital stay postoperatively.
Conclusions:
The use of MUF after CPB can produce an immediate improvement in lung compliance and gas exchange capacity, which may effectively minimize pulmonary dysfunction postbiventricular repair of congenital heart disease. However, these improvements are not sustained for the first 6 h postoperatively and do not reduce the duration of postoperative intubation, ICU stay, or total hospital stay.
