title: Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery.
abstract: OBJECTIVE
  Modified ultrafiltration is commonly used in pediatric cardiac surgery. Although its clinical benefits are currently debated, modified ultrafiltration has proved to improve mean arterial pressure in the first postoperative hours. Aim of our study was to measure cardiac index, stroke volume index, and mean arterial pressure modification before and after modified ultrafiltration by means of Pressure Recording Analytical Method.
  
  
  METHODS
  Single-center prospective observational cohort study.
  
  
  METHODS
  Pediatric cardiac surgery operating room.
  
  
  METHODS
  Children below 20 kg that are included in the "pediatric" mode of Pressure Recording Analytical Method.
  
  
  RESULTS
  Forty patients were enrolled in this study. Median age, weight, and body surface area at surgery were 3 months (interquartile range, 10 days to 3.5 yr), 5.6 (3.1-15) kg, and 0.31 (0.21-0.56), respectively. During the modified ultrafiltration procedure, a median volume of 17 mL/kg (11-25) was ultrafiltered and a median volume of 11 mL/kg (6-17) was reinfused with a median final modified ultrafiltration balance of -0.15 mL/kg (-4.0 to 0.1). By univariate analyses, there was a 10% increase in postmodified ultrafiltration mean, systolic and diastolic pressures (p = 0.01), stroke volume index (p = 0.02), and cardiac index (p = 0.001) without significant changes in heart rate, central (left and right) venous pressures, stroke volume variation, and inotropic score. By multivariate analysis, when controlling for cardiopulmonary bypass time and age at surgery, cardiac index variation was independently associated with lower preoperative body surface area (beta coefficient -5.5, p = 0.04).
  
  
  CONCLUSIONS
  According to Pressure Recording Analytical Method assessment, modified ultrafiltration acutely improves myocardial function, as shown by a 10% increase of systemic arterial pressure, stroke volume index, and cardiac index. This effect is more pronounced in smaller sized patients.
authors.affiliation: Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy. z.ricci@libero.it
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Roberta
authors.initials: R
authors.lastname: Netto
authors.forename: Francesca
authors.initials: F
authors.lastname: De Razza
authors.forename: Isabella
authors.initials: I
authors.lastname: Favia
authors.forename: Adriano
authors.initials: A
authors.lastname: Carotti
authors.forename: Paola E
authors.initials: PE
authors.lastname: Cogo
mesh_terms: D062186:Arterial Pressure; D001830:Body Surface Area; D002315:Cardiopulmonary Bypass / Q000379:methods; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D013318:Stroke Volume; D013696:Temperature