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Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants
David M Kwiatkowski1, Shina Menon2, Catherine D Krawczeski3
1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Peritoneal dialysis catheter (PDC) placement in infants undergoing heart surgery is safe and improves fluid balance and clinical outcomes. This supports considering routine PDC use for high-risk infants to reduce acute kidney injury (AKI).
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a significant complication in infants following cardiopulmonary bypass.
- Peritoneal dialysis (PD) shows promise in adults with AKI post-bypass, but pediatric evidence is scarce.
- This study investigates the impact of peritoneal dialysis catheter (PDC) placement during congenital heart surgery on AKI risk in infants.
Purpose of the Study:
- To determine if intraoperative PDC placement in infants undergoing congenital heart surgery is associated with improved clinical outcomes.
- To assess the safety and efficacy of PDC placement in high-risk infants for AKI.
Main Methods:
- A retrospective case-matched study comparing 42 infants with planned PDC placement (PDC+) to similar infants without PDC placement (PDC-).
- Demographic, baseline, and outcome data were analyzed.
- Primary outcome: negative fluid balance on postoperative days 1-3. Secondary outcomes included time to negative fluid balance, extubation, electrolyte correction, and inotrope scores.
Main Results:
- No significant difference in baseline data between PDC+ and PDC- groups.
- PDC+ group showed a higher percentage of negative fluid balance on postoperative days 1 and 2 (57% vs 33%; 85% vs 61%).
- PDC+ group experienced shorter time to negative fluid balance (16 vs 32 hours), earlier extubation (80 vs 104 hours), improved inotrope scores, and fewer electrolyte imbalances. PDC-related complications were infrequent.
Conclusions:
- Peritoneal dialysis catheter use is safe in infants undergoing cardiopulmonary bypass.
- PDC placement is linked to earlier negative fluid balance and better clinical outcomes in high-risk infants.
- Routine PDC use should be considered for infants undergoing cardiopulmonary bypass, with further prospective studies needed.
Background:
Acute kidney injury (AKI) is common in infants after cardiopulmonary bypass and is associated with poor outcomes. Peritoneal dialysis improves outcomes in adults with AKI after bypass, but pediatric data are limited. This retrospective case-matched study was conducted to determine if the practice of peritoneal dialysis catheter (PDC) placement during congenital heart surgery is associated with improved clinical outcomes in infants at high risk for AKI.
Methods:
Forty-two infants undergoing congenital heart surgery with planned PDC placement (PDC+) were age-matched to infants undergoing similar surgery without PDC placement (PDC-). Demographic, baseline and outcome data were compared. Our primary outcome was negative fluid balance on postoperative days 1 to 3. Secondary outcomes included time to negative fluid balance, time to extubation, frequency of electrolyte corrective medications, inotrope scores, and other clinical outcomes.
Results:
Baseline data did not differ between groups. The PDC+ group had a higher percentage of negative fluid balance on postoperative days 1 and 2 (57% vs 33%, P = .04; 85% vs 61%, P = .01). The PDC+ group had shorter time to negative fluid balance (16 vs 32 hours, P < .0001), earlier extubation (80 vs 104 hours, P = .02), improved inotrope scores (P = .04), and fewer electrolyte imbalances requiring correction (P = .03). PDC-related complications were rare.
Conclusions:
PDC use is safe and associated with earlier negative fluid balance and improved clinical outcomes in infants at high risk for AKI. Routine PDC use should be considered for infants undergoing cardiopulmonary bypass. Further prospective studies are essential to prove causative effects of PDC placement in this population.
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