Abstract
Objective(s): Modified ultrafiltration has gained wide acceptance as a powerful tool against cardiopulmonary bypass morbidity in pediatric cardiac surgery. The aim of our study was to assess the importance of modified ultrafiltration within conditions of contemporary cardiopulmonary bypass characteristics. Methods: Ninety–eight patients (overall cohort) weighing less than 12 kg undergoing surgical repair with cardiopulmonary bypass were prospectively enrolled in a randomized protocol to receive modified and conventional ultrafiltration (MUF group) or just conventional ultrafiltration (non-MUF group). A special attention was paid to forty-nine neonates and infants weighing less than 5 kg (lower weight (LW) cohort). Results: Post-filtration hematocrit was significantly higher in the MUF group for both cohorts (overall cohort p = 0.001; LW cohort p = 0.04), but not at other time points. During the postoperative course, patients in the MUF group received fewer packed red blood cells, (overall cohort p = 0.01; LW cohort p = 0.07), but required more fresh frozen plasma (overall cohort p = 0.04; LW cohort p = 0.05). There was no difference between groups in hemodynamic state, chest tube output, duration of mechanical ventilation, respiratory parameters, duration of intensive care unit, and hospitalization stay. Conclusions: If conventional ultrafiltration provides adequate hemoconcentration modified ultrafiltration does not provide additional positive benefits except for reduction in blood cell transfusion, This, however, comes at the cost of needing more fresh frozen plasma. Of particular importance is that this also applies to infants with weight bellow 5 kg where modified ultrafiltration was supposed to have the greatest positive impact.
Highlights
Cardiopulmonary bypasses (CPB), in pediatric cardiac surgery, significantly contributes to the development of postoperative morbidity
Ninety-eight children were enrolled in the study, and forty-nine of them weighed less than 5 kg (lower weight (LW) cohort))
Most of patients in both cohorts were operated in normothermia and mild hypothermia
Summary
Cardiopulmonary bypasses (CPB), in pediatric cardiac surgery, significantly contributes to the development of postoperative morbidity. Pediatric patients due to CPB develop a systemic inflammatory response syndrome (SIRS) which increases total body water and may result in multi-organ dysfunction. Ultrafiltration (UF), during and after CPB, is an important tool which mitigates these side effects. Standard pediatric UF techniques are conventional ultrafiltration (CUF) and modified ultrafiltration (MUF). CUF implies UF during CPB, whereas MUF is performed after CPB discontinuation. These techniques are not mutually exclusive but rather complementary. In the last 20 years numerous clinical studies have demonstrated that MUF can be effective in improving clinical outcomes. Reported benefits include: improved hemodynamic [3,4,5,6] and respiratory function [7,8,9,10], decreased chest tube output [11,12,13,14], reduced need for blood product transfusion [13,15,16], as well as increased hematocrit (Hct) [1,6,13,15,16,17], plasma proteins [15,16,17], and platelets (Plt) [15,16]
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