A Simplified Approach to Pediatric Modified Ultrafiltration: A Novel Circuit Design

Forsberg, Brian C.; Novick, William M.

doi:10.1051/ject/201345259

Cited by 5 publications

(1 citation statement)

References 11 publications

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“…The improvements in myocardial and hemodynamic functions after MUF are due to the ability of this procedure to enhance arterial blood pressure, global left ventricular function, cardiac index, systolic arterial pressure, and diastolic and systolic blood pressure [12]. The rationale for using MUF in pediatric patients/neonates is to minimize the risk of CPB-induced pulmonary dysfunction, as indicated by minimized gas exchange, high pulmonary vascular resistance, and compromised pulmonary compliance [13,14]. Several research studies have confirmed the role of MUF in improving static/dynamic lung compliance, minimizing lung injury, and enhancing the overall pulmonary function after cardiac surgery in pediatric patients [15,16].…”

Section: Introductionmentioning

confidence: 99%

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

MADHU A YADAV,

VALAJI JOSHNA,

SRINATH REDDY N

et al. 2024

Asian J Pharm Clin Res

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Objective: Cardiac surgeries involving cardiopulmonary bypass (CPB) can have adverse effects on patients, potentially increasing morbidity. In infants who possess lower blood volume and are exposed to the more artificial surface and larger prime volumes of the CPB, the harmful effects can be significant. Several studies have indicated that modified ultrafiltration (MUF) may yield beneficial effects in cardiac surgery by reducing inflammatory markers, improving hemodynamics, and decreasing excess body water. Our study seeks to evaluate the impact of MUF on pulmonary mechanics in infants undergoing cardiac surgeries on CPB. Methods: This prospective, observational, single-center study was conducted on 56 infants with congenital heart disease, who underwent cardiac surgery, followed by CPB, were included in this study. The primary outcomes were oxygen saturation (SPO2), hemoglobin (Hb), peak inspiratory pressure (Ppeak), and plateau pressure (Pplat). The secondary outcomes were systolic and diastolic invasive blood pressures (IBPs), mean arterial pressure (MAP), mean airway pressure (Pmean), static lung compliance (C-stat), dynamic lung compliance (C-dyn), expiratory resistance (Re), and work of breathing (WOB). Results: A statistically significant increase in SPO2 (98.7 vs. 99.1), Hb (8.3 vs. 13.3), IBPsystolic (85 vs. 90), IBPdiastolic (56 vs. 61.4), and MAP (66.4 vs. 73.2) was observed in congenital cardiac surgery and CPB patients after MUF (all p<0.05). A statistically significant post-procedural decline in Ppeak (18.8 vs. 18.3), Pplat (18.4 vs. 18.1), Re (79.8 vs. 78), and WOB (1.4 vs. 1.3) was also observed (all p<0.05). However, no significant pre-procedural versus post-procedural differences were observed in Pmean, C-stat, and C-dyn (all p>0.05). Conclusion: MUF effectively improved lung mechanics, oxygen saturation, myocardial contractility, hematocrit, and hemodynamics, and minimized the blood transfusion requirement after CPB in infants with congenital heart disease. Future studies should reinvestigate these outcomes with a larger sample size for an extended follow-up duration.

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Section: Introductionmentioning

confidence: 99%

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

MADHU A YADAV,

VALAJI JOSHNA,

SRINATH REDDY N

et al. 2024

Asian J Pharm Clin Res

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Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients

Constantinescu¹,

Adler

Watkins

et al. 2019

J Extra Corpor Technol

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Children with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) are at risk for fluid overload (FO) despite the normal estimated glomerular filtration rate (eGFR). It has been shown that survival in the intensive care unit (ICU) is inversely proportional to FO. Therefore, fluid removal, or prevention of FO, in these critical cases has the potential to improve survival. Aquapheresis (AQ), a procedure used for fluid removal, with success in patients with heart failure has also been used in children with acute oliguric kidney injury (AKI), to prevent and treat FO. The purpose of this article was to describe the use of Aquadex FlexFlow® for AQ in pediatric patients on ECMO, as a means to provide a simplified and safe form of fluid removal with minimal impact on ECMO therapy. The principal variables collected include patients’ demographics, urine output, serum creatinine, withdrawal and infusion pressures, ultrafiltration (UF) rates, and ECMO flow ranges, along with length of stay in pediatric ICU and survival. Patient survival was 100% with preserved eGFR. The ECMO flows were not affected by AQ. Urine output decreased somewhat during therapy, with little AQ machine pressure variations. Range of UF tolerated without hemodynamic abnormalities was 1.24–6.2 mL/kg/h, allowing the patients to maintain their pre-AQ body weight, while receiving intravenous (IV) nutrition and medications. This article describes the use of AQ in tandem with ECMO in a user-friendly and safe way to provide UF in children requiring cardiopulmonary support, with minimal flow and hemodynamic disturbance.

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Pro: The Value of Modified Ultrafiltration in Children After Cardiopulmonary Bypass

Ames

2019

Journal of Cardiothoracic and Vascular Anesthesia

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A Simplified Approach to Pediatric Modified Ultrafiltration: A Novel Circuit Design

Cited by 5 publications

References 11 publications

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients

Pro: The Value of Modified Ultrafiltration in Children After Cardiopulmonary Bypass

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