title: Modified versus conventional ultrafiltration in pediatric cardiac surgery: a meta-analysis of randomized controlled trials comparing clinical outcome parameters.
abstract: OBJECTIVE
  Although previous studies have demonstrated that modified ultrafiltration improves laboratory parameters in pediatric cardiac surgery, the clinical outcome data have been inconsistent. We performed a meta-analysis of randomized controlled trials comparing modified versus conventional ultrafiltration.
  
  
  METHODS
  We conducted a comprehensive search of the literature to identify clinical trials that met our inclusion criteria. To be included, studies had to be prospective randomized trials that compared modified ultrafiltration and conventional ultrafiltration in pediatric cardiac surgery using cardiopulmonary bypass. We focused on the following outcome variables: hematocrit and mean arterial blood pressure after cardiopulmonary bypass, amount of chest tube drainage after surgery, time to extubation, and length of stay in the intensive care unit. The random effects model was used to determine the pooled effect estimates. The estimators of treatment effects were expressed as the weighted mean difference with 95% confidence intervals. The heterogeneity of collected data was also evaluated.
  
  
  RESULTS
  We screened 54 studies, 8 of which satisfied our inclusion criteria. Combined analysis revealed that modified ultrafiltration resulted in significantly higher postbypass hematocrit and higher mean arterial blood pressure. Benefits in postoperative blood loss, ventilator time, and intensive care unit stay were not apparent. There was significant heterogeneity among the studies surveyed.
  
  
  CONCLUSIONS
  The advantage of modified ultrafiltration over conventional ultrafiltration consists of significant improvement of clinical conditions in the immediate postbypass period. The postoperative outcome parameters were not significantly influenced. We should also take into account possible clinical or methodologic variations in the currently available ultrafiltration studies.
authors.affiliation: Division of Pediatric Anesthesia, International University of Health and Welfare Hospital, Tochigi, Japan. nori-kuratani@umin.ac.jp
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kuratani
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Bunsangjaroen
authors.forename: Thanaphon
authors.initials: T
authors.lastname: Srimueang
authors.forename: Eiji
authors.initials: E
authors.lastname: Masaki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Katogi
mesh_terms: D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D015505:Chest Tubes; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000295:instrumentation; D019317:Evidence-Based Medicine; D006400:Hematocrit; D006440:Hemofiltration / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome