title: The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery.
abstract: BACKGROUND
  Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery.
  
  
  METHODS
  A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups.
  
  
  RESULTS
  At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P< 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P= 0.004) and ICU stay (P= 0.007) between the two groups. Inotropes including milrinone (P= 0.04), epinephrine (P= 0.001), and dobutamine (P= 0.002) were used significantly less frequently for patients in the intervention than the control group.
  
  
  CONCLUSIONS
  Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.
authors.affiliation: Department of Cardiac Anesthesiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ziyaeifard
authors.affiliation: Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Azin
authors.initials: A
authors.lastname: Alizadehasl
authors.affiliation: Department of Cardiac Anesthesiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Aghdaii
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hazrat Rasul Medical Complex, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Poupak
authors.initials: P
authors.lastname: Rahimzadeh
authors.affiliation: Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Masoumi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samad Ej
authors.initials: SE
authors.lastname: Golzari
authors.affiliation: Department of Perfusion, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Fatahi
authors.affiliation: Department of Perfusion, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Gorjipur
keywords: Congenital; hemodynamic; mechanical ventilation; ultrafiltration