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Factors affecting the clinical outcomes in pediatric post-cardiotomy patients requiring perioperative peritoneal
Ahmet Hulisi Arslan1, Tamer Aksoy2, Murat Ugur3
1Anadolu Medical Center, Department of Cardiovascular Surgery - Kocaeli, Turkey.
Insights
Peritoneal dialysis in pediatric cardiac surgery can prevent fluid overload and electrolyte imbalances, improving patient outcomes. Early initiation is key for hemodynamic stability in young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Nephrology
Background:
- Fluid overload is a significant risk factor for mortality and morbidity in pediatric cardiac surgery patients.
- Peritoneal dialysis offers a method to manage fluid balance and electrolyte disturbances, potentially improving outcomes.
- Hemodynamic stability can be preserved with peritoneal dialysis due to its passive drainage characteristics.
Purpose of the Study:
- To evaluate the outcomes of peritoneal dialysis in pediatric patients following cardiac surgery.
- To assess the efficacy of peritoneal dialysis in managing fluid overload and electrolyte imbalance in this population.
Main Methods:
- A retrospective study was conducted on pediatric patients who underwent cardiac surgery between December 2010 and January 2020.
- Patients requiring peritoneal dialysis during their hospitalization were included.
- Clinical status and outcomes were analyzed.
Main Results:
- Peritoneal dialysis was utilized in 89 pediatric patients (age range: newborn to 4 years).
- Indications included prophylactic use in 68.5% and treatment in 31.5%.
- Mortality was observed in 31 patients, with risk factors including younger age, longer cardiopulmonary bypass, prolonged intubation/inotropic support, and ECMO requirement.
Conclusions:
- Early initiation of peritoneal dialysis in pediatric cardiac surgery is beneficial for maintaining hemodynamic stability.
- It effectively avoids fluid overload and aids in managing electrolyte imbalances, which are challenging to treat.
- Peritoneal dialysis presents a valuable supportive therapy in postoperative pediatric cardiac care.
Objective:
Fluid overload is associated with increased mortality and morbidity in pediatric cardiac surgery. In the pediatric age group, peritoneal dialysis might improve postoperative outcome with avoiding fluid overload and electrolyte imbalance. It preserves hemodynamic status with the advantage of passive drainage. In this study, we are reporting our results of peritoneal dialysis after cardiac surgery.
Methods:
In this retrospective study, we evaluated the patients who underwent pediatric cardiac surgery in our hospital between December 2010 and January 2020. Patients who required peritoneal dialysis during hospitalization period were included in the study. Patients' clinical status and outcomes were evaluated.
Results:
Peritoneal dialysis was performed to 89 patients during the study period. The age varies from the newborn to 4 years old. The indication of peritoneal dialysis was prophylactic in 68.5% (n=61) and for the treatment in 31.5% (n=28). There were 31 mortalities. The risk factors for the mortality were preoperative lower age, longer cardiopulmonary bypass time, lengthened intubation, lengthened inotropic support, and requirement of extracorporeal membrane oxygenation (p<0.0001).
Conclusion:
Earlier initiation of peritoneal dialysis in pediatric cardiac surgery helps maintain hemodynamic instability by avoiding fluid overload, considering the difficulty in the treatment of electrolyte imbalance and diuresis.
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