Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants.

Abstract

Evaluation of the acute hemodynamic changes during peritoneal dialysis in patients with low cardiac output syndrome and acute renal failure after open heart surgery. Three newborns and three infants after corrective surgery of congenital heart disease with post cardiotomy dialysis. Five of these had an open thorax during dialysis. Cardiac output measurements using the thermodilution technique on two consecutive days at four different times during the peritoneal dialysis cycle. We did not find a deterioration of the cardiac index or systemic vascular resistance measured over two cycles in each of the six patients. Pulmonary artery pressure rose slightly after instillation of the dialysate solution in all patients. Changes in central venous pressure and left atrial pressure were not clinically meaningful. In all patients fluid removal by peritoneal dialysis was effective. All five surviving patients recovered renal function. Peritoneal dialysis can be performed in newborns and infants following cardiac surgery without causing acute hemodynamic imbalances. An open chest may have a significant impact on hemodynamic stability during peritoneal dialysis by blunting any possible negative alterations of increased intraabdominal pressure.