title: Peritoneal Drainage Versus Pleural Drainage After Pediatric Cardiac Surgery.
abstract: We aimed to determine whether infants undergoing cardiac surgery would more efficiently attain negative fluid balance postoperatively with passive peritoneal drainage as compared to traditional pleural drainage.
  
  
  
  A prospective, randomized study including children undergoing repair of tetralogy of Fallot (TOF) or atrioventricular septal defect (AVSD) was completed between September 2011 and June 2013. Patients were randomized to intraoperative placement of peritoneal catheter or right pleural tube in addition to the requisite mediastinal tube. The primary outcome measure was fluid balance at 48 hours postoperatively. Variables were compared using t tests or Fisher exact tests as appropriate.
  
  
  
  A total of 24 patients were enrolled (14 TOF and 10 AVSD), with 12 patients in each study group. Mean fluid balance at 48 hours was not significantly different between study groups, -41 ± 53 mL/kg in patients with periteonal drainage and -9 ± 40 mL/kg in patients with pleural drainage (P = .10). At 72 hours however, postoperative fluid balance was significantly more negative with peritoneal drainage, -52.4 ± 71.6 versus +2.0 ± 50.6 (P = .04). On subset analysis, fluid balance at 48 hours in patients with AVSD was more negative with peritoneal drainage as compared to pleural, -82 ± 51 versus -1 ± 38 mL/kg, respectively (P = .02). Fluid balance at 48 hours in patients with TOF was not significantly different between study groups.
  
  
  
  Passive peritoneal drainage may more effectively facilitate negative fluid balance when compared to pleural drainage after pediatric cardiac surgery, although this benefit is not likely universal but rather dependent on the patient's underlying physiology.
authors: Department of Pediatrics, Division of Critical Care, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Keshava Murty Narayana
authors: KM
authors: Gowda
authors: Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Marwan
authors: M
authors: Zidan
authors: Department of Pediatric Cardiovascular Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Henry L
authors: HL
authors: Walters
authors: Department of Pediatric Cardiovascular Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Ralph E
authors: RE
authors: Delius
authors: Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indianapolis, IN, USA cmastrop@iupui.edu.
authors: Christopher W
authors: CW
authors: Mastropietro
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010537:Peritoneum / Q000601:surgery*; D010994:Pleura / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: atrioventricular septal defect; congenital heart surgery; pleural space; postoperative care