Effect of peritoneal dialysis on intra-abdominal pressure and cardio-respiratory function in infants following cardiac surgery.
OBJECTIVE
To investigate the relationship between dialysate volume, intra-abdominal pressure, and cardio-respiratory function in infants following cardiac surgery.


METHODS
Prospective pilot study.


METHODS
Paediatric intensive care unit.


METHODS
Six infants undergoing peritoneal dialysis within 24 h of cardiopulmonary bypass.


METHODS
Manipulation of the volume of dialysate at levels of 0, 10, 20, and 30 ml/kg in variable order.


RESULTS
Intra-abdominal pressure was measured at each volume of dialysate via a pressure transducer connected to the dialysis catheter. Haemodynamic data was collected, including cardiac output, which was measured by thermodilution via a 3.5-French gauge catheter placed in the pulmonary arterial pathway. Respiratory data included PaO2, PaCO2, and dynamic compliance. Intra-abdominal pressure increased with increasing volume of dialysate (p < 0.001), though there was considerable variation between patients in the magnitude of increase. Intra-abdominal pressure remained low even with 30 ml/kg in the abdomen. In three infants, intra-abdominal pressure was re-measured in the absence of muscle relaxants, and was found to be higher in each case. No negative effects on cardiac output, markers of delivery of oxygen, or respiratory function were seen even at volumes of 30 ml/kg. Cardiac index was significantly higher with 10 ml/kg than when the abdomen was empty or contained a larger volume (p < 0.05).


CONCLUSIONS
In this small group of infants, intra-abdominal pressure increased with increasing volumes of dialysate but remained low, even with 30 ml/kg in the abdomen, and was not associated with any deleterious effects on cardio-respiratory performance.
Morris
Kevin P
KP
Department of Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Victoria, Australia. kevin.morris@bch.nhs.uk
Butt
Warwick W
WW
Karl
Tom R
TR
D000005:Abdomen / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D015314:Dialysis Solutions / Q000008:administration & dosage; D006330:Heart Defects, Congenital / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010530:Peritoneal Dialysis; D010865:Pilot Projects; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012129:Respiratory Function Tests
D015314:Dialysis Solutions