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Modified ultrafiltration in paediatric cardiac surgery
L Schlünzen1, J Pedersen, K Hjortholm
1Department of Anaesthesia, Aarhus University Hospital, Denmark.
Insights
Modified ultrafiltration (MUF) in pediatric cardiac surgery significantly improves blood pressure, hematocrit, and oxygenation. This technique also reduces heart rate and postoperative fluid overload in children with congenital heart disease.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Congenital heart disease necessitates complex surgical interventions, often involving cardiopulmonary bypass.
- Managing hemodynamics and fluid balance post-cardiopulmonary bypass is critical in pediatric cardiac surgery.
- Modified ultrafiltration (MUF) is a technique used to manage fluid and improve hemoconcentration.
Purpose of the Study:
- To evaluate the effects of modified ultrafiltration (MUF) after cardiopulmonary bypass in pediatric patients.
- To assess the impact of MUF on hemodynamic parameters, oxygenation, and fluid balance.
- To determine the safety and efficacy of MUF in moderate to severe congenital heart disease.
Main Methods:
- A prospective study involving 138 pediatric patients undergoing cardiac surgery.
- Application of modified ultrafiltration (MUF) post-cardiopulmonary bypass.
- Monitoring of hematocrit, systolic arterial pressure, arterial blood gases, heart rate, and central venous pressure before and after MUF.
Main Results:
- MUF significantly increased hematocrit (28% to 36%) and systolic arterial pressure (56 to 74 mmHg).
- Arterial oxygenation (30.8 to 34.1 kPa) and carbon dioxide tension (4.8 to 5.1 kPa) also significantly increased.
- Heart rate significantly decreased (145 to 136 beats/min) post-MUF, with no significant changes in central venous or left atrial pressure.
Conclusions:
- Modified ultrafiltration (MUF) is effective in improving hemodynamic stability and gas exchange immediately after cardiopulmonary bypass in pediatric cardiac surgery.
- MUF leads to hemoconcentration and improved blood pressure, while reducing heart rate.
- The findings suggest MUF is a valuable adjunct for managing patients with moderate to severe congenital heart disease, reducing postoperative fluid overload.
Abstract:
The effect of modified ultrafiltration (MUF) after cardiopulmonary bypass for paediatric cardiac surgery was evaluated in 138 children with moderate to severe congenital heart disease. The median age was 0.4 years (0 days to 6.5 years), and the weight 5.3 kg (2.2-20 kg). The operation was discontinued in six cases, three because of technical problems and three because of unstable circulation. One-hundred-and-thirty-four patients were ultrafiltrated for a median of 12 min (2-27 min) with an ultrafiltrate of median 44 ml/kg (6-118 ml/kg). Haematocrit was significantly increased from 28% (20-39%) to 36% (26-51%) and systolic arterial pressure from 56 mmHg (30-85 mmHg) to 74.0 mmHg (32-118 mmHg). Furthermore arterial oxygenation was significantly increased from 30.8 kPa (4.8-70.4 kPa) to 34.1 kPa (4.9-80.6 kPa), and arterial carbon dioxide tension from 4.8 kPa (3.1-7.3 kPa) to 5.1 kPa (3.1-7.6 kPa). Heart rate was significantly reduced from 145 beats/min (92-201 beats/min) to 136 beats/min (88-200 beats/min). There were no significant differences in central venous pressure, left atrial pressure and base excess before and after MUF. MUF increases systolic blood pressure, haematocrit, arterial oxygen and carbon dioxide tension coming off bypass in paediatric cardiac surgery and reduces heart rate and postoperative fluid overload.