Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes.
| Title: | Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes. |
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| Authors: | Sasser WC; Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.; Dabal RJ; Askenazi DJ; Borasino S; Moellinger AB; Kirklin JK; Alten JA |
| Source: | Congenital heart disease [Congenit Heart Dis] 2014 Mar-Apr; Vol. 9 (2), pp. 106-15. Date of Electronic Publication: 2013 May 07. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Tech Science Press Country of Publication: United States NLM ID: 101256510 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-0803 (Electronic) Linking ISSN: 1747079X NLM ISO Abbreviation: Congenit Heart Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2020- : Henderson, Nevada : Tech Science Press; Original Publication: Malden, MA : Blackwell Pub., c2006- |
| MeSH Terms: | Peritoneal Dialysis*/adverse effects ; Water-Electrolyte Balance*; Cardiac Surgical Procedures/*adverse effects ; Cardiopulmonary Bypass/*adverse effects ; Heart Defects, Congenital/*surgery ; Inflammation/*prevention & control ; Water-Electrolyte Imbalance/*prevention & control; Diuretics/therapeutic use ; Heart Defects, Congenital/diagnosis ; Inflammation/blood ; Inflammation/diagnosis ; Inflammation/immunology ; Inflammation Mediators/blood ; Interleukin-6/blood ; Interleukin-8/blood ; Water-Electrolyte Imbalance/diagnosis ; Water-Electrolyte Imbalance/etiology ; Water-Electrolyte Imbalance/physiopathology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Prospective Studies ; Respiration, Artificial ; Time Factors ; Treatment Outcome |
| Abstract: | Objective: To investigate impact of prophylactic peritoneal dialysis (PD) on clinical outcomes and inflammatory cytokines in children following cardiac surgery with cardiopulmonary bypass.; Design: Prospective before-and-after nonrandomized cohort study.; Setting: Pediatric cardiovascular intensive care unit in tertiary hospital.; Patients: Fifty-two consecutive neonates and infants at high risk for postoperative fluid overload following cardiopulmonary bypass. All had PD catheters placed during primary cardiac surgery.; Intervention: Initial 27 patients were managed with passive peritoneal drainage and diuretics (controls). Following 25 patients were started on prophylactic PD in immediate postoperative period and managed per PD protocol (+PD).; Outcome Measures: Cumulative fluid balance, indices of disease severity, and clinical outcomes were prospectively collected. Plasma interleukin-6 and interleukin-8 were measured immediately before-and-after cardiopulmonary bypass and at 24 and 48 hours post-cardiopulmonary bypass.; Results: Demographics, diagnoses, and intraoperative variables were similar. Median net fluid balance was more negative in +PD at 24 hours, -24 mL/kg (interquartile range: -62, 11) vs. +18 mL/kg (interquartile range: -26, 11), P = .003, and 48 hours, -88 mL/kg (interquartile range: -132, -54) vs. -46 mL/kg (interquartile range: -84, -12), P = .004. +PD had median 55 mL/kg less fluid intake at 24 hours, P = .058. Peritoneal drain, urine, and chest tube output were comparable over first 24 hours. Mean inotrope score was lower in +PD at 24 hours. +PD had earlier sternal closure--24 hours (interquartile range: 20, 40) vs. 63 hours (interquartile range: 44, 72), P < .001--and a trend toward shorter duration of mechanical ventilation--71 hours (interquartile range: 49, 135) vs. 125 hours (interquartile range: 70, 195), P = .10. +PD experienced lower serum concentrations of interleukin-6 and interleukin-8 at 24 hours.; Conclusions: Prophylactic PD is associated with greater net negative fluid balance, decreased inotrope requirements, and lower serum concentrations of inflammatory cytokines in the early postoperative period.; (© 2013 Wiley Periodicals, Inc.) |
| Contributed Indexing: | Keywords: Cardiopulmonary Bypass; Congenital Heart Disease; Fluid Overload; Neonate; Peritoneal Dialysis; Postoperative Care |
| Substance Nomenclature: | 0 (CXCL8 protein, human); 0 (Diuretics); 0 (IL6 protein, human); 0 (Inflammation Mediators); 0 (Interleukin-6); 0 (Interleukin-8) |
| Entry Date(s): | Date Created: 20130508 Date Completed: 20141230 Latest Revision: 20190816 |
| Update Code: | 20260130 |
| DOI: | 10.1111/chd.12072 |
| PMID: | 23647999 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't