Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management

Patients requiring cardiopulmonary bypass for congenital heart surgery commonly exhibit impaired renal function and extravascular fluid retention. These conditions contribute to early postoperative fluid overload, which may result in significant morbidity and mortality. We examined the safety and efficacy of peritoneal dialysis in removing extravascular fluid from critically ill postcardiotomy patients. A retrospective case review from July of 1995 through April of 1996 was conducted. All patients undergoing peritoneal dialysis achieved a net negative fluid balance. Average urine output increased from 2.1 cc/kg/hr to 3.9 cc/kg/hr (P < 0.01) during the pre-peritoneal dialysis to post-peritoneal dialysis period, and the mean number of inotropic agents decreased from 2.2 to 1.7 (P < 0.05). Controlled comparison revealed that the peritoneal dialysis cohort more rapidly achieved a negative weight-adjusted fluid balance throughout the early postoperative course. The peritoneal dialysis group's illness severity decreased more rapidly within the 24-hour period after initiation of peritoneal dialysis than did that of the control cohort over the same period of time. No difference in postoperative morbidity or mortality existed between the study groups. Complications from the catheter placement were minimal, and no patient experienced peritonitis or metabolic or hemodynamic instability during peritoneal dialysis catheter placement, usage, or removal. Peritoneal dialysis is a safe and effective form of renal replacement therapy, even among critically ill pediatric postcardiotomy patients. Early postsurgical institution of peritoneal dialysis may hasten early postoperative recovery. We speculate that intraoperative catheter placement reduces the complication rate associated with this treatment modality.