Passive Peritoneal Drainage Impact on Fluid Balance and Inflammatory Mediators: A Randomized Pilot Study

Area of Science:

• Pediatric Surgery
• Critical Care Medicine
• Cardiovascular Surgery

Background:

• Infants undergoing cardiopulmonary bypass face risks of inflammatory mediator release and fluid overload.
• Passive peritoneal drainage is explored as a method to manage these complications.

Purpose of the Study:

• To assess the impact of prophylactic passive peritoneal drainage on fluid balance in infants post-cardiopulmonary bypass.
• To evaluate the ability of passive peritoneal drainage to manage inflammatory cytokines in this patient population.

Main Methods:

• A randomized pilot study involving infants undergoing major cardiac surgery (STAT category 3-5).
• Infants were assigned to either a prophylactic passive peritoneal drain group or a control group.
• Key outcomes included time to negative fluid balance, diuretic index, and perioperative inflammatory cytokine levels (serum and peritoneal fluid).

Main Results:

• The passive peritoneal drain group achieved negative fluid balance significantly faster (median 1.42 days vs. 3.08 days).
• Patients with peritoneal drains used less diuretic at 72 hours postoperatively (median 2.86 vs. 6.27).
• Elevated inflammatory cytokines were found in peritoneal fluid compared to serum, but serum levels did not differ between groups postoperatively.

Conclusions:

• Prophylactic passive peritoneal drainage facilitates earlier negative fluid balance and reduced diuretic requirements in infants post-cardiac surgery.
• While effective for fluid management, the drain did not significantly alter systemic serum cytokine levels.
• No significant differences were observed in mortality or postoperative length of stay between the groups.