title: Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes.
abstract: OBJECTIVE
  To investigate impact of prophylactic peritoneal dialysis (PD) on clinical outcomes and inflammatory cytokines in children following cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Prospective before-and-after nonrandomized cohort study.
  
  
  METHODS
  Pediatric cardiovascular intensive care unit in tertiary hospital.
  
  
  METHODS
  Fifty-two consecutive neonates and infants at high risk for postoperative fluid overload following cardiopulmonary bypass. All had PD catheters placed during primary cardiac surgery.
  
  
  METHODS
  Initial 27 patients were managed with passive peritoneal drainage and diuretics (controls). Following 25 patients were started on prophylactic PD in immediate postoperative period and managed per PD protocol (+PD).
  
  
  METHODS
  Cumulative fluid balance, indices of disease severity, and clinical outcomes were prospectively collected. Plasma interleukin-6 and interleukin-8 were measured immediately before-and-after cardiopulmonary bypass and at 24 and 48 hours post-cardiopulmonary bypass.
  
  
  RESULTS
  Demographics, diagnoses, and intraoperative variables were similar. Median net fluid balance was more negative in +PD at 24 hours, -24 mL/kg (interquartile range: -62, 11) vs. +18 mL/kg (interquartile range: -26, 11), P = .003, and 48 hours, -88 mL/kg (interquartile range: -132, -54) vs. -46 mL/kg (interquartile range: -84, -12), P = .004. +PD had median 55 mL/kg less fluid intake at 24 hours, P = .058. Peritoneal drain, urine, and chest tube output were comparable over first 24 hours. Mean inotrope score was lower in +PD at 24 hours. +PD had earlier sternal closure--24 hours (interquartile range: 20, 40) vs. 63 hours (interquartile range: 44, 72), P < .001--and a trend toward shorter duration of mechanical ventilation--71 hours (interquartile range: 49, 135) vs. 125 hours (interquartile range: 70, 195), P = .10. +PD experienced lower serum concentrations of interleukin-6 and interleukin-8 at 24 hours.
  
  
  CONCLUSIONS
  Prophylactic PD is associated with greater net negative fluid balance, decreased inotrope requirements, and lower serum concentrations of inflammatory cytokines in the early postoperative period.
authors: Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors: William C
authors: WC
authors: Sasser
authors: Robert J
authors: RJ
authors: Dabal
authors: David J
authors: DJ
authors: Askenazi
authors: Santiago
authors: S
authors: Borasino
authors: Ashley B
authors: AB
authors: Moellinger
authors: James K
authors: JK
authors: Kirklin
authors: Jeffrey A
authors: JA
authors: Alten
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
chemical_list: C508606:CXCL8 protein, human; D004232:Diuretics; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8
keywords: Cardiopulmonary Bypass; Congenital Heart Disease; Fluid Overload; Neonate; Peritoneal Dialysis; Postoperative Care