Anesthesia & Clinical Research
Open Access

Abstract

Conventional Ultrafiltration Versus Combined Conventional and Modified Ultrafiltration on Clinical Outcomes of Pediatric Cardiac Surgery

Sanjeev Singh and Deigheidy Ehab Mahrous

Background: Ultrafiltration is a method used to decrease body fluid volume and tissue oedema as the consequences of hemodilution after cardiac surgery with cardiopulmonary bypass (CPB). Combined conventional (CUF) and modified ultrafiltration (MUF) may offer advantages in comparison with conventional ultrafiltration. We conducted a prospective study to compare clinical outcomes between two groups.

Material and methods: A simple randomized clinical trial was conducted on eighty pediatric patients undergoing congenital heart surgery on cardiopulmonary bypass. Patient management was standardized, and intensive care staffs were blinded to group allocation. Preoperative Aristotle comprehensive complexity level, ultrafiltrate volumes, perioperative hemodynamic data, hematocrit, Transesophageal echocardiographically (TEE) determined ejection fraction (EF), fractional area change (FAC), temperature drift, arterial oxygenation, time of extubation, ventilation, comparison of inotropic drugs, postoperative chest tube drainage, intensive care unit (ICU) and hospital stay were recorded in CUF (group I) and CUF plus MUF (group II).

Results: There was no operative mortality. Technical difficulties prevented completion of modified ultrafiltration in 3 patients of 40 in group II. In this study there were 27 females (33.75%) and 53 males (66.25%) with median age 441 days, mean weight 10.19 kg and Aristotle comprehensive complexity score level-2. Group II had greater ultrafiltrate volume (883 ± 82.7 ml; (p=0.014). Duration of ventilatory support was 61.4 ± 13.74 hours versus 103.2 ± 25.85 hours in group II and I respectively, (p=0.004). Chest tube drainage in the first 48 hours was (79.31 ± 47 and 107.63 ± 23.83 ml) in group II and I respectively, (p=0.003). EF and FAC were 10% and 4% higher at 45 minutes in group II. Inotropic infusion requirement was significantly less in group II compared to group I. Group II maintained better systolic blood pressure and hemoglobin after CPB.

Conclusion: The advantage of combining conventional and modified ultrafiltration over conventional ultrafiltration consists of significant improvement of clinical conditions, as decreases the need for homologous blood transfusion, reduced requirement of inotropic drugs, and shortened duration of ventilatory support as well as average hospital length of stay.