Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants.
OBJECTIVE
Evaluation of the acute hemodynamic changes during peritoneal dialysis in patients with low cardiac output syndrome and acute renal failure after open heart surgery.


METHODS
Three newborns and three infants after corrective surgery of congenital heart disease with post cardiotomy dialysis. Five of these had an open thorax during dialysis.


METHODS
Cardiac output measurements using the thermodilution technique on two consecutive days at four different times during the peritoneal dialysis cycle.


RESULTS
We did not find a deterioration of the cardiac index or systemic vascular resistance measured over two cycles in each of the six patients. Pulmonary artery pressure rose slightly after instillation of the dialysate solution in all patients. Changes in central venous pressure and left atrial pressure were not clinically meaningful. In all patients fluid removal by peritoneal dialysis was effective. All five surviving patients recovered renal function.


CONCLUSIONS
Peritoneal dialysis can be performed in newborns and infants following cardiac surgery without causing acute hemodynamic imbalances. An open chest may have a significant impact on hemodynamic stability during peritoneal dialysis by blunting any possible negative alterations of increased intraabdominal pressure.
Dittrich
S
S
Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. svsdittr@aol.com
Vogel
M
M
Dähnert
I
I
Haas
N A
NA
Alexi-Meskishvili
V
V
Lange
P E
PE
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D002303:Cardiac Output, Low / Q000209:etiology / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010530:Peritoneal Dialysis; D011183:Postoperative Complications / Q000628:therapy*; D012121:Respiration, Artificial