Use Of Modified Ultrafiltration Research Articles

Modified Ultrafiltration and Acute Kidney Injury in Patients Undergoing Open Heart Surgery Using Cardiopulmonary Bypass

Objective: To determine the incidence of acute kidney injury (AKI) in patients undergoing open heart surgery using cardiopulmonary bypass (CBP) with and without modified ultrafiltration (MUF). Materials and Methods: A total of 150 patients who underwent open heart surgery using CPB in our hospital from Jan-2022 to Dec-2022. In group A patients MUF was performed during the CPB and atleast 1000 ml of volume was removed using MUF. While in group B patients, no filtration was performed during CPB. In ICU all patients were followed till three days after surgery to determine the incidence of AKI. Results: Mean age was 53.4±10.9 years in MUF group versus 55.6±11.8 years in control group, p-value 0.23. Majority, 53 (70.7%) patients were male in MUF and 57 (76%) in control group, p-value 0.55. Mean CPB time was 101.6±45.2 mins in MUF and 96.5±39.1 mins in control group, p-value 0.46. Mean X-clamp time was 47.5±19.3 mins in MUF and 51.4±21.6 mins in control group, p-value 0.43. The incidence of AKI was comparable, with frequency rate of 3 (4.0%) in MUF group versus 1 (1.3%) in control group, p-value 0.31. Conclusion: In present study, the incidence of AKI in MUF and control group was almost similar. So according to the results of present study, the use of MUF has no role in preventing or aggravating AKI in patients undergoing CPB. Keywords: Acute kidney injury, cardiopulmonary bypass, modified ultrafiltration.

Effect of modified ultrafiltration in patients undergoing coronary surgery using cardiopulmonary bypass. A literature review

Aim: The purpose of this research is to describe the benefits of modified ultrafiltration (MUF) in cardiac surgery patients, especially in coronary revascularization patients. Introduction: The modified ultrafiltration is the new generation of ultrafiltration, which is used to filtrates the excess water and low molecular weight substances like IL-6, IL-8, TNF and endothelin out of the blood. These excess fluid and low molecular weight substances are the main factors of post-operative complications in coronary artery bypass graft patients. There is limited information about the use of MUF in adult surgery, but is mostly used in congenital cardiac surgery patients. It is found to be very beneficial in pediatric cardiac surgery, but we need more data for using it in adult cardiac surgery Material and Methods: This is a review article; in which we used the articles collected from world’s creditable journals and platforms. These articles have published since 2000. Results: From articles which we reviewed, 17 were about the benefits of MUF in congenital cardiac surgery and 8 articles were about the favorable effects of MUF in adult cardiac surgery. The rest of the articles were related indirectly to the MUF. About 5 of these researches proved the beneficial role of MUF on lungs functions after surgery, in 4 researches confirmed the significant decrease in post-operative bleeding and the need for blood transfusion, in 5 researches it has been measured that the level of inflammatory factors like interleukins, TNF and endothelin were decreased. In 6 articles the role of MUF in welfare of kidney functions were emphasized. And 1 article discussed about the benefits of MUF on cerebral metabolism correction. Nearly in all of the articles it was mentioned that MUF decreases the time of ventilation and vigorous urination after surgery. Conclusion: Modified ultrafiltration (MUF) is a technique which decreases the post-operation complications due to cardio-pulmonary bypass, and could be beneficial in CABG patients.

Effect of Modified Ultrafiltration on Pulmonary Function After Cardiopulmonary Bypass

Effect of Modified Ultrafiltration on Pulmonary Function After Cardiopulmonary Bypass

EARLY INFECTIOUS PULMONARY COMPLICATIONS IN AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) RECIPIENTS

Pulmonary dysfunction is one of the most common manifestations of inflammatory response after cardiopulmonary bypass (CPB). This prospective randomized study was conducted to evaluate the effect of a modified ultrafiltration (MUF) technique on pulmonary function after CPB in children. Forty patients weighing from 5 to 10 kg with congenital heart disease who required CPB for primary biventricular operative repair were prospectively randomized into two groups. The control group received conventional ultrafiltration (CUF) during CPB, and the study group received CUF and MUF. Pulmonary compliance (static and dynamic) and gas exchange capacity of the lung expressed as oxygen index, respiratory index, ventilation index, and alveolar-arterial oxygen pressure difference were measured after intubation (baseline), at the termination of CPB, at the end of MUF, on admission to the ICU, and 6 h postoperatively. There was no significant difference in lung compliance and gas exchange between the two groups before CPB. CPB produced a significant decrease in static and dynamic lung compliance in both groups. In the control group, static and dynamic lung compliance decreased from 1.0 +/- 0.3 to 0.90 +/- 0.3 mL/cm/kg and 0.87 +/- 0.2 to 0.71 +/- 0.1 mL/cm/kg (+/- SE) [p = 0.0002 and p = 0.002, respectively]. In the study group, static and dynamic lung compliance decreased from 1.0 +/- 0.2 to 0.89 +/- 0.03 mL/cm/kg and 0.94 +/- 0.2 to 0.77 +/- 0.1 mL/cm/kg (p = 0.002 and p = 0.002, respectively). There was no significant difference in the decrease in static (p = 0.9) or dynamic lung compliance (p = 0.3) between the two groups. MUF produced a significant immediate improvement in both static lung compliance (0.89 +/- 0.2 to 0.98 +/- 0.2 mL/cm/kg, p = 0.03) and dynamic lung compliance (0.77 +/- 0.1 to 0.93 +/- 0.2 mL/cm/kg, p = 0.007). The same was observed regarding the gas exchange capacity. CPB produced a significant decrease in lung gas exchange capacity, and MUF produced a significant immediate improvement in lung gas exchange capacity. The effect of MUF on lung compliance and gas exchange capacity was not sustained after admission to the ICU nor 6 h later postoperatively. There was no significant difference in the time of extubation between the two groups (12 +/- 3 h and 13 +/- 2 h, p = 0.4), the length of ICU stay, or the total hospital stay postoperatively. The use of MUF after CPB can produce an immediate improvement in lung compliance and gas exchange capacity, which may effectively minimize pulmonary dysfunction postbiventricular repair of congenital heart disease. However, these improvements are not sustained for the first 6 h postoperatively and do not reduce the duration of postoperative intubation, ICU stay, or total hospital stay.

An Analysis of Oxygen Consumption and Oxygen Delivery in Euthermic Infants After Cardiopulmonary Bypass With Modified Ultrafiltration

Background The balance between systemic oxygen consumption (V̇O 2) and delivery (DO 2) is impaired after cardiopulmonary bypass (CPB) and is related to systemic inflammatory response syndrome. We sought to assess V̇O 2 and DO 2 and their relationship with proinflammatory cytokines after CPB with the use of modified ultrafiltration (MUF) in infants. Methods Sixteen infants, aged 1–11.5 months (median, 6.3 months), undergoing hypothermic CPB with MUF were studied during the first 12 hours after arrival in the intensive care unit (ICU). The central temperature was maintained at 36.8–37.1°C using external cooling or warming. V̇O 2 was continuously measured using respiratory mass spectrometry. Arterial blood samples for the tumor necrosis factor (TNF), interleukin-6 (IL-6), and interleukin-8 (IL-8) were taken and DO 2 was calculated using the Fick principle on arrival at the ICU, and 2, 4, 8, and 12 hours postoperatively. Cytokines were additionally measured after induction of anesthesia and at the end of MUF. Results V̇O 2 significantly decreased by 18.8% during the study period. DO 2 was depressed throughout this period and reached a nadir at 8 hours (357.1 ± 136.2 ml · min −1 · m −2). The decrease in cytokines was accompanied with the decrease in V̇O 2 despite varied relationships between the levels of each of the cytokines and V̇O 2 measurements. Conclusions Our data indicate an unusual continuous decrease in V̇O 2 during the first 12 hours after CPB in infants. Control of body temperature to maintain euthermia in addition to the use of MUF may be beneficial to the balance between V̇O 2 and DO 2 in the early postoperative period.

Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass?

Cardiopulmonary bypass (CPB) is associated with an accumulation of total body water and a systemic inflammatory response syndrome (SIRS), which, in turn, is associated with organ dysfunction and postoperative morbidity. It has been suggested that modified ultrafiltration (MUF) may be capable of reducing SIRS and improving clinical outcome by filtering out the inflammatory mediators generated during CPB. This paper reviews the data regarding the use of MUF in paediatric and adult settings. Specifically, three issues will be considered: 1) Does MUF improve clinical outcome? 2) Does MUF reduce the systemic inflammatory response to cardiac surgery with CPB? 3) Is MUF more effective than conventional ultrafiltration in improving clinical outcome?

The effect of modified ultrafiltration on the postoperative course in patients with congenital heart disease

Improvements in the technology of cardiopulmonary bypass have significantly reduced morbidity following repair of congenital cardiac defects. However, the use of cardiopulmonary bypass exposes infants to extremes of hemodilution and hyperthermia, often in association with tissue ischemia. Exposure of the blood to surfaces of the bypass circuit initiates a systemic inflammatory response that may result in organ dysfunction after cardiopulmonary bypass, especially the heart, lungs, and brain. The technique of modified ultrafiltration (MUF) was introduced by Naik and colleagues at the Hospital for Sick Children in London over 10 years ago. Since that time, multiple studies have evaluated the effects of MUF on organ function and postoperative morbidity following repair of congenital heart defects. Use of MUF after cardiopulmonary bypass reverses hemodilution and decreases tissue edema resulting in improved pulmonary function with decreased duration of postoperative ventilation, improved left ventricular function, decreased postoperative bleeding, and a decrease in the incidence and duration of pleural effusions following the Fontan procedure. Despite the increasing evidence that the use of MUF reduces postoperative morbidity, many important questions remain unresolved. The mechanisms by which MUF results in these beneficial effects requires additional investigation. In addition, further studies are necessary to identify patients most likely to benefit from MUF and to define the optimal protocols for its use. In the future, prospective randomized studies incorporating recent advances in the technology of cardiopulmonary bypass will be necessary to define the optimal utilization of ultrafiltration during and after cardiopulmonary bypass.

The effect of modified ultrafiltration on the postoperative course in patients with congenital heart disease

Abstract Improvements in the technology of cardiopulmonary bypass have significantly reduced morbidity following repair of congenital cardiac defects. However, the use of cardiopulmonary bypass exposes infants to extremes of hemodilution and hyperthermia, often in association with tissue ischemia. Exposure of the blood to surfaces of the bypass circuit initiates a systemic inflammatory response that may result in organ dysfunction after cardiopulmonary bypass, especially the heart, lungs, and brain. The technique of modified ultrafiltration (MUF) was introduced by Naik and colleagues at the Hospital for Sick Children in London over 10 years ago. Since that time, multiple studies have evaluated the effects of MUF on organ function and postoperative morbidity following repair of congenital heart defects. Use of MUF after cardiopulmonary bypass reverses hemodilution and decreases tissue edema resulting in improved pulmonary function with decreased duration of postoperative ventilation, improved left ventricular function, decreased postoperative bleeding, and a decrease in the incidence and duration of pleural effusions following the Fontan procedure. Despite the increasing evidence that the use of MUF reduces postoperative morbidity, many important questions remain unresolved. The mechanisms by which MUF results in these beneficial effects requires additional investigation. In addition, further studies are necessary to identify patients most likely to benefit from MUF and to define the optimal protocols for its use. In the future, prospective randomized studies incorporating recent advances in the technology of cardiopulmonary bypass will be necessary to define the optimal utilization of ultrafiltration during and after cardiopulmonary bypass. Copyright 2003 Elsevier, Inc. All rights reserved.

Alleviating Heat Loss Associated with Modified Ultrafiltration

Modified ultrafiltration (MUF) has been described and utilized for the removal of extracellular water in the immediate postcardiopulmonary bypass (CPB) period. This technique has been associated with improved hematological status and hemodynamic stability post cardiopulmonary bypass. Hypothermia during the MUF period has been described as a complication associated with this technique. Decreased patient temperature may be associated with increased bleeding causing an increase in time to sternal re-approximation, OR time, decreases in cardiac function, peripheral vascular perfusion, and an increase in blood product utilization. These complications may reduce some of the benefits described with the use of MUF. The purpose of this study was to evaluate the use of a heated MUF infusion line to reduce the heat loss associated with this technique in a pediatric population. After obtaining Committee for Protection of Human Subjects exemption, a retrospective review to evaluate the efficiency of the hot MUF infusion line was undertaken. Twenty patients under 10 kg who underwent MUF before the change to a heated infusion line were retrospectively identified and matched to patients undergoing MUF with a heated infusion line with regard to weight, lesion, procedure, surgical staff and technique, and disposable equipment. Groups were evaluated for temperature and hematocrit change during the MUF period, blood loss and transfusion postprotamine in the OR and 24 h, and time to sternal re-approximation postprotamine. Statistical significance was seen between the two groups in temperature (−0.24 ± 0.72 vs. − 1.58 ± 0.89°C; p < .0001) with the HotLine group having little change post MUF. Significance was also seen in the last OR temperature recorded (37.0 ± 1.2 vs. 36.0 ± 1.0°C; p = .01) with the HotLine group having the higher temperature. There were no significant differences in hematocrit levels at 24 hours, last in the OR, or the change after the MUF period. No significant difference was found in blood transfused postprotamine in the OR, 24-h blood transfused, 24-h chest tube loss, or sternal closure. The study suggests that the use of a heated MUF infusion line safely reduces the heat loss associated with MUF in the immediate post-operative period.

Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease

Background. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease. Methods. Informed consent was obtained from 100 consecutive patients with complex congenital heart disease undergoing operations with CPB. They were randomized into a control group (n = 50) of conventional ultrafiltration during bypass and an experimental group using dilutional ultrafiltration during bypass and venovenous modified ultrafiltration after bypass (MUF group, n = 50). Postoperative arterial oxygenation, duration of ventilatory support, transfusion requirements, hematocrit, chest tube output, and time to chest tube removal were compared between the groups stratified by age and weight, CPB technique, existence of preoperative pulmonary hypertension, and diagnosis. Results. There were no MUF-related complications. In patients with preoperative pulmonary hypertension, MUF significantly improved postoperative oxygenation (445 ± 129 mm Hg versus control: 307 ± 113 mm Hg, p = 0.002), shortened ventilatory support (42.9 ± 29.5 hours versus control: 162.4 ± 131.2 hours, p = 0.0005), decreased blood transfusion (red blood cells: 16.2 ± 18.2 mL/kg versus control: 41.4 ± 27.8 mL/kg, p = 0.01; coagulation factors: 5.3. ± 6.9 mL/kg versus control: 32.3 ± 15.5 mL/kg, p = 0.01), and led to earlier chest tube removal. In neonates (≤30 days), MUF significantly reduced transfusion of coagulation factors (5.4 ± 5.0 mL/kg versus control: 39.9 ± 25.8 mL/kg, p = 0.007), and duration of ventilatory support (59.3 ± 36.2 hours versus 242.1 ± 143.1 hours, p = 0.0009). In patients with prolonged CPB (>120 minutes), MUF significantly reduced the duration of ventilatory support (44.7 ± 37.0 hours versus 128.7 ± 133.4 hours, p = 0.002). No significant differences were observed between MUF and control patients for any parameter in the presence of ventricular septal defect without pulmonary hypertension, tetralogy of Fallot, or aortic stenosis. Conclusions. Modified ultrafiltration after CPB is safe and decreases the need for homologous blood transfusion, the duration of ventilatory support, and chest tube placement in selected patients with complex congenital heart disease. The optimal use of MUF includes patients with preoperative pulmonary hypertension, neonates, and patients who require prolonged CPB.

Use of Modified Ultrafiltration After Repair of Congenital Heart Defects

The use of cardiopulmonary bypass (CPB) for repair of congenital heart defects exposes children to extremes of hemodilution and hypothermia. Exposure of blood to the foreign surfaces of the oxygenator and bypass circuit initiates a systemic inflammatory response. Adverse effects of CPB include increased capillary permeability and increased total body water (TBW), which often results in tissue edema and multiple organ dysfunction. A variety of techniques have been developed for reversing tissue edema and hemodilution after CPB, including ultrafiltration during CPB, postoperative peritoneal dialysis, postoperative continuous arterial venous hemofiltration, and aggressive use of diuretics. A technique termed modified ultrafiltration (MUF) has been developed at the Hospital for Sick Children in London. Unlike conventional ultrafiltration, MUF is performed in the immediate post-CPB period and removes excess water from the patient as well as provides a method of salvaging blood from the circuit. MUF has been shown to modulate the inflammatory response to CPB by removing inflammatory mediators including interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF). A prospective randomized trial of MUF showed improved hemodynamics with a reduction in TBW and decreased need for blood transfusion when compared with nonfiltered controls. MUF has been shown to improve left ventricular systolic function after CPB, resulting in increased systolic blood pressure and cardiac index. In a recent study, use of MUF significantly reduced the incidence of pleural effusions after cavopulmonary connection and the Fontan procedure. MUF is a useful adjunct to CPB in children and significantly decreases perioperative morbidity. Copyright 1998 by W.B. Saunders Company