![]() ![]() Peritoneal dialysis and diuretics are usually used to treat fluid overload or oliguria, however one single-centre non-blinded prospective cohort (before-and-after) study found improved clinical outcomes in children following cardiopulmonary bypass when PD was used prophylactically. Early initiation of PD was associated with decreased mortality (OR 0.43, 95% CI 0.23-0.80), a shorter duration of mechanical ventilation (-1.09 days, 95% CI -1.09d to -0.33d) and decreased length of PICU stay (-2.46d, 95% CI -3.57d to -1.35d). The second meta-analysis looked explicitly at early PD (commenced within 24 hours of operation) versus late/not at all in infants following cardiac surgery. There were no differences in PICU length of stay and degree of negative fluid balance by postoperative day one or peritonitis. It found that PD was associated with a shorter duration of mechanical ventilation (-1.25 days, p = 0.008) but led to increased mortality (OR 2.27 p = 0.02). The first compared PD with diuretics in children following cardiac surgery. Two recent systematic reviews and meta-analyses have been conducted (including the above trial), and a small number of observational studies (with marked heterogeneity in the results). No serious complications were noted in either group, though PD was discontinued early in 22% of patients due to pleuro-peritoneal communications. The length of stay was similar between groups. There was no statistically significant difference in mortality, although the study was underpowered. Vasoactive medications were used longer, and more electrolyte abnormalities were found in the furosemide group. However, the furosemide group was three times more likely to have 10% fluid overload (OR 3.0, 95% CI 1.3-6.9) and prolonged ventilator use (OR 3.1, 95% CI 1.2-8.2). There was no significant difference between groups in the primary outcome – incidence of negative fluid balance on postoperative day 1. If they developed oliguria (4 hours of urine output <1ml/kg/hr in the first 24 postoperative hours), they were randomised to either furosemide (IV 1mg/kg 6-hourly) or a standardised PD regimen. ![]() This single-centre non-blinded study recruited infants (<6 months) undergoing cardiac surgery with peritoneal catheter placement. Only one randomised controlled trial has directly compared PD with diuretic therapy for oliguria following cardiac surgery. What is the evidence for one treatment over the other? They wondered whether they should commence a furosemide infusion or peritoneal dialysis. The team diagnosed fluid overload which was hampering progress. The PICU pharmacist reviewed the medication list given the renal impairment and adjusted doses accordingly. Oxygenation had worsened (PEEP 8, FiO2 0.45).Īn echocardiogram found no residual structural lesion but mildly impaired biventricular systolic function. They were up 130ml, and blood tests revealed a stage 2 AKI with mild hyperkalaemia. The LCOS was treated with cautious intravenous crystalloid boluses (in 5ml/kg aliquots), escalating vasoactive infusions (adrenaline, noradrenaline and milrinone) and deep sedation.īy 20 hours post-operatively, the LCOS was improving, but urine output remained poor (0.6ml/kg/hr). In addition, they had mild lactataemia (3) and an increased oxygen extraction ratio ( 50%) 10. They were tachycardic (170), mildly hypotensive with a narrow pulse pressure (50/38, mean 42), weak pulses, and cool peripheries with a delayed capillary refill time (4s). It was uncomplicated, and they were admitted, intubated, to paediatric cardiac intensive care on a low-dose adrenaline infusion and had chest and peritoneal drains in situ.Īround 8 hours post-operatively, signs of low cardiac output syndrome (LCOS) developed. The operation was performed via open sternotomy on cardiopulmonary bypass. A 3-month-old 4.5kg infant underwent elective repair of a significant ventricular septal defect because of worsening congestive cardiac failure symptoms and poor growth despite fluid restriction and diuretics. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |