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[Role for preliminary and continuous hemodialysis during extracorporeal circulation in infants and children]
K Nomura1, M Yamagishi, Y Nakamura
1Department of Cardiovascular Surgery, Saitama Children's Medical Center, Japan.
Insights
Preliminary hemodialysis during extracorporeal circulation (ECC) in children stabilizes perfusion pressure and maintains adequate urine output. This method achieves a negative water balance, proving beneficial for infants undergoing prolonged ECC.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal circulation (ECC) in pediatric patients can lead to complications.
- Maintaining hemodynamic stability and fluid balance during ECC is crucial.
- The role of hemodialysis in mitigating ECC-related issues in children requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of preliminary and continuous hemodialysis during ECC in pediatric patients.
- To compare hemodynamic parameters and fluid balance between hemodialysis and control groups.
- To determine if preliminary hemodialysis prevents perfusion pressure drops during ECC.
Main Methods:
- Three groups of eight children each were studied: preliminary hemodialysis (HD-I), preliminary and continuous hemodialysis (HD-II), and a control group without hemodialysis.
- Measurements included urine volume during ECC, perfusion pressure, and water balance.
- Statistical analysis was performed to compare outcomes among the groups.
Main Results:
- Both HD-I and HD-II groups showed increased urine volume during ECC compared to the control, though not significantly.
- Perfusion pressures remained stable in HD-I and HD-II groups, unlike the control group which experienced a temporal decrease.
- The control group exhibited a positive water balance, while both hemodialysis groups achieved a negative water balance (p < 0.05 and p < 0.04).
Conclusions:
- Preliminary hemodialysis is effective in pediatric ECC by stabilizing perfusion pressure and ensuring adequate urine output.
- Achieving a net negative water balance is a key benefit of preliminary hemodialysis during ECC.
- Preliminary hemodialysis can enhance the utility of continuous hemodialysis in infants requiring prolonged ECC.
Abstract:
The efficacy of both preliminary and continuous hemodialysis during extracorporeal circulation (ECC) was evaluated in the pediatric population. Preliminary hemodialysis of the priming solution was initiated in eight children (HD-I group), while both preliminary and continuous hemodialysis during ECC was performed in another eight children (HD-II group). The control group which consisted of eight children did not undergo hemodialysis. Urine volume during ECC, perfusion pressure, and water balance were measured and compared among the three groups. In the HD-I and HD-II groups, the total urine volume during ECC was greater than in control group, but there was no significant difference. In the control group, the perfusion pressure temporally decreased after the pump was operating for five minutes, but the perfusion pressures remained stable in the HD-I and HD-II groups. Therefore, preliminary hemodialysis appears to prevent the "initial drop" seen in perfusion pressures. Water balance in the control group tended to be in positive balance, but both the HD-I and HD-II groups appeared to be in negative balance. Significant differences between HD-I and HD-II in contrast to the control group (p < 0.05) and p < 0.04, respectively) were observed. Preliminary hemodialysis is useful during ECC in infants and children because by maintaining perfusion pressure urine output remains adequate while a net negative water balance is achieved. Preliminary hemodialysis will increase the continuous hemodialysis in infants who are subjected to prolonged extracorporeal circulation.