Abstract
Objective: This study aims to investigate the effect of optimized ultrafiltration on perioperative electrolytes, acid–base balance, and pulmonary function during cardiopulmonary bypass (CPB) in infants with low body weight (under 10 kg), using traditional balanced ultrafiltration and modified ultrafiltration.Methods: A total of 30 children who underwent surgical correction for congenital heart disease in Changzhou Children's Hospital between January 2018 and December 2019 were randomly divided into two groups. In the treatment group, ultrafiltration pre-treatment was carried out with blood-containing priming fluid prior to CPB. Balanced ultrafiltration was performed during the operation, and optimized and modified ultrafiltration were conducted before closing and extubation. In the control group, traditional balanced ultrafiltration was used during the operation, and a modified ultrafiltration combination was used before closing and extubation. Indexes such as blood gas analysis and electrolytes were measured perioperatively, and pulmonary function was observed.Results: No deaths were reported in either group. The ventilator-assisted breathing time was shorter in the treatment group than in the control group (P < 0.05). The indexes of the treatment group were closer than those of the control group to the optimal physiological values. The concentrations of potassium ion (K+), lactate (Lac), and blood glucose (Glu) decreased, and there was significant difference between the two groups (P < 0.05) at the end of CPB. Hemoglobin (Hb) and hematocrit (HCT) in the treatment group increased (P < 0.01). Alveolar-arterial differences for oxygen (A-aDO2) and respiratory index (RI) increased significantly in both groups after operation. Children in the treatment group began to recover lung function earlier than children in the control group. Both A-aDO2 and RI were lower in the treatment group than in the control group at each time point after operation (P < 0.05).Conclusion: Optimizing and modifying the traditional ultrafiltration combination method can effectively shorten the ultrafiltration time, reduce the adverse impacts of the ultrafiltration technique, and improve the lung function of infants after operation.
Highlights
The amount of priming fluid used in cardiopulmonary bypass (CPB) is significantly higher in infants than in adults, especially in infants with body weight below 10 kg
The concentrations of K+, Lac, and Glu decreased in the treatment group, and were significantly different at the end of CPB from concentrations in the control group (P < 0.05)
Lung function tended to recover earlier in the treatment group. Both A-aDO2 and respiratory index (RI) were significantly lower in the treatment group than in the control group (P < 0.05)
Summary
The amount of priming fluid used in cardiopulmonary bypass (CPB) is significantly higher (with respect to body surface area) in infants than in adults, especially in infants with body weight below 10 kg. Because of infants’ low blood volume and the incomplete development of the immune system, vascular endothelial system, lung function, and kidney drainage function, changes in priming fluid composition and the interaction of related factors in the course of CPB have a significant influence on the internal environment of infants, and there is increased likelihood of acute kidney and lung injury [1,2,3]. As such, mitigating these adverse factors for children with a body weight below 10 kg is very important. The effects of this were monitored and compared with the effects of traditional intraoperative balanced ultrafiltration and modified ultrafiltration before closing and extubation on the control group, in order to observe any adverse impacts of traditional ultrafiltration on the control group and identify reduction of tissue edema or improved lung function in the treatment group
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