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Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery
Kevin A Pettit1, Nicholas A Schreiter2, Entela B Lushaj3
1Department of Pediatrics, The American Family Children's Hospital, University of Wisconsin Hospital and Clinics, 1675 Highland Ave, Madison, WI, 53792, USA.
Insights
Passive peritoneal drains (PPD) increased fluid output and reduced diuretic use in infants after congenital heart surgery (CHS). This intervention may aid fluid management in complex CHS cases, though it did not impact overall outcomes.
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.
Abstract:
Infants undergoing congenital heart surgery (CHS) with cardiopulmonary bypass (CPB) are at risk of acute kidney injury (AKI) and fluid overload. We hypothesized that placement of a passive peritoneal drain (PPD) can improve postoperative fluid output in such infants. We analyzed 115 consecutive patients, age birth to 60 days, admitted to the PICU after CHS with CPB between 2012 and 2018. Patients who needed postoperative ECMO were excluded. Linear and logistic regression models compared postoperative fluid balances, diuretics administration, AKI, vasoactive-inotropic scores (VIS), time intubated, and length of stay after adjusting for pre/operative predictors including STAT category, bypass time, age, weight, and open chest status. PPD patients had higher STAT category (p = 0.001), longer CPB times (p = 0.001), and higher VIS on POD 1-3 (p ≤ 0.005 daily). PPD patients also had higher AKI rates (p = 0.01) that did not reach significance in multivariable modeling. There were no postoperative deaths. Postoperative hours of intubation, hospital length of stay, and POD 1-5 fluid intake did not differ between groups. Over POD 1-5, PPD use accounted for 48.8 mL/kg increased fluid output (95% CI [2.2, 95.4], p = 0.043) and 3.41 mg/kg less furosemide administered (95% CI [1.69, 5.14], p < 0.001). No PPD complications were observed. Although PPD placement did not affect end-outcomes, it was used in higher acuity patients. PPD placement is associated with improved fluid output despite lower diuretic administration and may be a useful postoperative fluid management adjunct in some complex CHS patients.
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