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Continuous extracorporeal fluid removal in children with low cardiac output after cardiac operations
Insights
Slow continuous ultrafiltration and continuous arteriovenous hemofiltration effectively improved cardiovascular function, acid-base balance, and gas exchange in pediatric patients with low cardiac output post-cardiac surgery. These fluid removal techniques optimized preload conditions for failing hearts.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Nephrology
Background:
- Post-cardiac surgery in children can lead to hypervolemia, oliguria, and low cardiac output.
- Managing fluid balance and hemodynamic status is critical for improving outcomes in these vulnerable patients.
Purpose of the Study:
- To evaluate the efficacy of slow continuous ultrafiltration (SCUF) and continuous arteriovenous hemofiltration (CAVH) in improving cardiovascular function and gas exchange.
- To assess the impact of fluid removal on hemodynamic parameters, acid-base balance, and need for supportive therapies.
Main Methods:
- Eleven hypervolemic, oliguric children with low cardiac output post-operation were treated with SCUF or CAVH.
- Continuous fluid removal was performed, aiming for a negative fluid balance.
- Hemodynamic parameters, acid-base status, oxygenation, and need for vasopressors/ventilation were monitored.
Main Results:
- A mean negative fluid balance of 1.63 ml/kg/hr significantly improved hemodynamic status within 59 hours.
- Central venous pressure decreased, while mean arterial pressure, pH, and oxygenation index significantly increased.
- Catecholamine infusion rates decreased, and 8 out of 11 patients were weaned from ventilation and vasopressors.
Conclusions:
- SCUF and CAVH are effective in improving cardiovascular function in pediatric patients with low cardiac output by optimizing preload.
- These extracorporeal fluid removal techniques also enhance acid-base balance and pulmonary gas exchange.
- Fluid management through SCUF/CAVH can facilitate recovery and reduce the need for intensive supportive care.
Abstract:
Eleven hypervolemic and oliguric children with low cardiac output after cardiac operations were treated by slow continuous ultrafiltration or continuous arteriovenous hemofiltration. A mean negative fluid balance of 1.63 +/- 0.37 ml/kg/hr (standard error of the mean [SEM]) significantly improved the hemodynamic status within 59 +/- 6.1 hours (SEM). Although the central venous pressure decreased significantly from 15.2 +/- 0.84 to 8.8 +/- 0.92 mm Hg (p less than 0.0001), the mean arterial pressure increased significantly from 41.5 +/- 2.54 to 53.5 +/- 2.21 mm Hg (p less than 0.001). In addition, pH increased significantly from 7.31 +/- 0.01 (SEM) to 7.43 +/- 0.001 (SEM) (p less than 0.001) and oxygenation index (arterial oxygen tension/inspired oxygen fraction) from 119 +/- 15.2 (SEM) to 214 +/- 27.0 (SEM) (p less than 0.001). Hemodynamic improvement during slow continuous extracorporeal fluid removal allowed a significant decrease of the catecholamine infusion rate. After normovolemia had been achieved, continuous arteriovenous hemofiltration had to be continued in four children because of persistent anuria. Eight patients could be weaned from artificial ventilation and vasopressor support. Two patients died without recovery of renal function and one with restored renal function. Slow continuous ultrafiltration and continuous arteriovenous hemofiltration improve the cardiovascular function in children with low cardiac output by optimizing the preload conditions of the failing heart. In addition, they improve acid-base balance and pulmonary gas exchange.