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Modified ultrafiltration after cardiopulmonary bypass in pediatric cardiac surgery
A M Draaisma1, M G Hazekamp, M Frank
1Department of Cardiothoracic Surgery, University Hospital Leiden, The Netherlands.
Insights
Modified ultrafiltration significantly reduces blood transfusions and chest drain loss in pediatric cardiac surgery patients. This technique helps manage fluid overload after cardiopulmonary bypass, improving patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) in pediatric patients causes significant fluid retention, particularly in neonates.
- Excessive fluid accumulation can prolong mechanical ventilation and intensive care unit (ICU) stays.
- Modified ultrafiltration (MUF) is a technique to remove excess plasma water post-CPB.
Purpose of the Study:
- To evaluate the efficacy of modified ultrafiltration in pediatric cardiac surgery.
- To assess the impact of MUF on fluid balance, blood transfusion needs, and postoperative drainage.
Main Methods:
- Retrospective analysis of 198 pediatric patients undergoing cardiac operations (1991-1994).
- Comparison between 99 patients with MUF and 99 patients without MUF.
- Analysis of CPB prime volume, blood transfusion volumes, chest drain output, hemoglobin, and hematocrit levels.
Main Results:
- MUF significantly increased hemoglobin and hematocrit levels.
- Patients undergoing MUF required significantly less blood transfusion.
- Mean postoperative chest drain loss was significantly lower in the MUF group.
Conclusions:
- Modified ultrafiltration effectively reduces the need for blood transfusions in pediatric cardiac surgery.
- MUF also significantly decreases postoperative chest drain loss.
- This technique aids in managing fluid overload and potentially improves recovery post-pediatric cardiac procedures.
Background:
Cardiopulmonary bypass in children results in considerable water retention, especially in neonates and small infants. Dilution of plasma proteins increases water loss into the extravascular compartments. Excessive total body water may prolong ventilatory support and may contribute to a prolongation of intensive care convalescence. After discontinuation of cardiopulmonary bypass, modified ultrafiltration can be used to withdraw plasma water from the total circulating volume.
Methods:
This retrospective study included 198 pediatric patients who underwent cardiac operations in the period from September 1991 to November 1994. Two groups were compared: 99 patients without ultrafiltration and 99 patients receiving modified ultrafiltration. The following indices were analyzed: cardiopulmonary bypass prime volume, transfused blood volume during and after the operation, postoperative chest drain loss, and hemoglobin and hematocrit levels before, during, and after the procedure.
Results:
Modified ultrafiltration resulted in a significant increase in hemoglobin and hematocrit levels and a significantly lower amount of transfused blood. Mean postoperative chest drain loss was significantly less in the patients who underwent modified ultrafiltration.
Conclusions:
Modified ultrafiltration decreases blood transfusion requirements and chest drain loss after pediatric cardiac surgical procedures.