title: The benefits of continuous ultrafiltration in pediatric cardiac surgery.
abstract: BACKGROUND
  Systemic inflammatory response and capillary leak syndrome, caused by extracorporeal circulation, have negative effects on the function of vital organs during the postoperative period. Modified ultrafiltration (MUF) has been developed as an alternative method to reduce the detrimental effects of cardiopulmonary bypass. The aim of this prospective, randomized study is to analyze the effects of MUF in a pediatric population undergoing congenital cardiac surgery.
  
  
  METHODS
  Twenty-seven patients who underwent open-heart surgery at our institution were included in this prospective study. They were randomized into two groups as follows: Group I (n=14) of conventional ultrafiltration during bypass and Group II (n=13) receiving both conventional and modified ultrafiltration during and after the cessation of the bypass, respectively. The amount of prime volume, postoperative chest drain loss, transfusion requirements, hemodynamical parameters, duration of mechanical ventilatory support, and length of intensive care unit stay were compared between the two groups. During the postoperative period, the concentrations of hematological, biochemical and inflammatory parameters were also compared by analyzing the blood samples obtained at various time points.
  
  
  RESULTS
  MUF resulted in a significant increase in hemoglobin, hematocrit and platelet levels, and significantly reduced the amount of chest tube output and transfused blood and blood products. MUF also shortened the duration of postoperative mechanical ventilatory support, length of the intensive care unit stay and improved postoperative hemodynamical parameters. During the early postoperative hours, IL-8 is significantly reduced in patients undergoing MUF, however, the concentrations of IL-8 were similar in both groups at the end of 24 h.
  
  
  CONCLUSIONS
  MUF decreases the duration of mechanical ventilatory support, the length of intensive care unit stay, the need for blood transfusion and improves postoperative hemodynamics. It is associated with increased levels of hemoglobin, hematocrit and platelets. We can conclude that MUF attenuates the inflammatory response by decreasing the levels of inflammatory mediators.
authors.affiliation: Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Sever
authors.forename: Turkan
authors.initials: T
authors.lastname: Tansel
authors.forename: Murat
authors.initials: M
authors.lastname: Basaran
authors.forename: Eylul
authors.initials: E
authors.lastname: Kafali
authors.forename: Murat
authors.initials: M
authors.lastname: Ugurlucan
authors.forename: Omer
authors.initials: O
authors.lastname: Ali Sayin
authors.forename: Ufuk
authors.initials: U
authors.lastname: Alpagut
authors.forename: Enver
authors.initials: E
authors.lastname: Dayioglu
authors.forename: Ertan
authors.initials: E
authors.lastname: Onursal
mesh_terms: D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D016209:Interleukin-8