Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery

Area of Science:

• Pediatric Surgery
• Cardiology
• Nephrology

Background:

• Infants undergoing congenital heart surgery (CHS) with cardiopulmonary bypass (CPB) face risks of acute kidney injury (AKI) and fluid overload.
• Effective postoperative fluid management is critical for improving outcomes in these vulnerable patients.

Purpose of the Study:

• To investigate if a passive peritoneal drain (PPD) can enhance postoperative fluid output in infants following CHS with CPB.
• To assess the impact of PPD placement on fluid balance, diuretic use, AKI rates, and other clinical outcomes.

Main Methods:

• A retrospective analysis of 115 infants (birth to 60 days) undergoing CHS with CPB between 2012 and 2018.
• Comparison of fluid balance, AKI, diuretic administration, vasoactive-inotropic scores (VIS), intubation time, and length of stay between patients with and without PPD.
• Statistical analysis using linear and logistic regression, adjusting for pre/operative predictors.

Main Results:

• Patients receiving PPD had higher acuity (STAT category), longer CPB times, and higher VIS.
• PPD use was associated with significantly increased postoperative fluid output (48.8 mL/kg) and decreased furosemide administration (3.41 mg/kg) over 5 days.
• No significant difference in AKI rates, intubation time, or length of stay was observed between groups in multivariable analysis.

Conclusions:

• Passive peritoneal drain placement in infants after CHS is associated with improved fluid output and reduced diuretic needs.
• While not impacting overall clinical outcomes, PPD may serve as a valuable adjunct for fluid management in select complex CHS patients.
• No complications were reported with PPD use.