Modified and conventional ultrafiltration during pediatric cardiac surgery: clinical outcomes compared.
OBJECTIVE
This prospective study compared clinical outcomes after heart surgery between three groups of infants with congenital heart disease. One group received dilutional conventional ultrafiltration (group D), another received modified ultrafiltration (group M), and a third group received both dilutional conventional and modified ultrafiltration (group B). We hypothesized that group B patients would have the best clinical outcome.


METHODS
Children younger than 1 year undergoing heart surgery for biventricular repair by the same surgeon were randomly allocated to one of the three study groups. Patient management was standardized, and intensive care staff were blinded to group allocation. Primary outcome measure was duration of postoperative mechanical ventilation. Other outcome measures recorded included total blood products transfused, duration of chest tube in situ, chest tube output, and stays in intensive care and in the hospital.


RESULTS
Sixty infants completed study protocol. Mean age and weight were as follows: group D (n = 19), 61 days, 4.3 kg; group M (n = 20), 64 days, 4.5 kg; and group B (n = 21), 86 days, 4.4 kg. Preoperative and intraoperative characteristics were similar between groups. Ultrafiltrate volumes obtained were 196 +/- 93 mL/kg in group D, 105 +/- 33 mL/kg in group M, and 261 +/- 113 mL/kg in group B. There were no significant differences between groups for any outcome variable. Technical difficulties prevented completion of modified ultrafiltration in 2 of 41 infants.


CONCLUSIONS
There was no clinical advantage in combining conventional and modified ultrafiltration. Because clinical outcomes were similar across groups, relative risks of the ultrafiltration strategies may influence choice.
Williams
Glyn D
GD
Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif 94305-5640, USA. jumbo@stanford.edu
Ramamoorthy
Chandra
C
Chu
Larry
L
Hammer
Gregory B
GB
Kamra
Komal
K
Boltz
Madalane G
MG
Pentcheva
Krassimira
K
McCarthy
James P
JP
Reddy
Vadiyala M
VM
D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome