Do peritoneal catheters remove pro-inflammatory cytokines after cardiopulmonary bypass in neonates?

Bokesch, Paula M.; Kapural, Miranda; Mossad, Emad B.; Cavaglià, Marco; Appachi, Elumalai; Drummond-Webb, Jonathan J.; Mee, Roger B.B.

doi:10.1016/s0003-4975(00)01453-3

Cited by 72 publications

(58 citation statements)

References 18 publications

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“…Despite less impressive than other studies, MUF clearly minimized some of the burdens in neonates undergoing ASO, thereby assisting quick recovery of this entity. When this novel perfusion technique emerged in the early 1990s, it was hypothesized that MUF attenuates capillary leak, especially in small infants, by removing excessive fluid as well as some proinflammatory cyokines; 14,20 however, this hypothesis has never been tested in any previous studies. In the present study, we compared the changes of the amount of peritoneal fluid between the groups as a parameter of capillary leakage because neonates and infants have a particular propensity for capillary leakage into the peritoneal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…21 Although insignificant, there was a trend toward reduced peritoneal fluid discharge in the first 24 h in the MUF-treated group. Given the fact that the major factors causing capillary leakage are hemodilution, fluid overload and inflammatory response, 14,20 it can be hypothesized that MUF could, not perfectly but partly, address these major factors, thereby potentially attenuating capillary leak after neonatal open-heart surgery. Obviously, this speculation is based on insignificant findings seen in the present study, which is not valid enough to draw a strong conclusion, but further study on the effects of MUF on capillary leak syndrome following CPB is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Modified Ultrafiltration on Postoperative Course in Neonates With Complete Transposition of the Great Arteries Undergoing Arterial Switch Operation

Kotani

Honjo

Osaki

et al. 2008

Circ J

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verall outcomes of neonatal open-heart surgery have been dramatically improved over the past 2 decades owing to refinements of preoperative, intraoperative and postoperative management. The current early mortality rate of patients with transposition of the great arteries (TGA) with intact atrial septum (TGA-IAS) and TGA with ventricular septal defect (TGA-VSD) undergoing arterial switch operation (ASO) is approximately 2-7%, 1,2 a considerable improvement from the mortality rate of about 15% in earlier eras. 3 Interest has therefore been shifted from reducing operative mortality to facilitating quicker recovery and reducing intensive care unit (ICU) stay and hospital stay by applying an early extubation policy and/or fast-track cardiac surgery pathways. [4][5][6] However, stress response to cardiopulmonary bypass (CPB) is much greater in neonates than in older children, 7 and postoperative recovery in neonates can therefore often be compromised by CPB-induced organ dysfunction.Modified ultrafiltration (MUF), which was introduced by Naik et al in 1991, has become an essential perfusion strategy to minimize CPB-induced adverse effects in pediatric patients undergoing open-heart surgery. 8 A substantial body of evidence showed that MUF improves cardiac, pulmonary and cerebral functions 9-12 and decreases postoperative bleeding and blood transfusion requirement 13 by reduction of body water accumulation, reversal of hemodilution, and modulation of systemic inflammatory mediators. 9,14 The beneficial effects of MUF are thought to be greatest in neonates who have the largest body weight/CPB circuit volume mismatch and are therefore most vulnerable to exposure to hypothermia and crystalloid hemodilution; however, the effect of MUF on clinical outcomes in neonates undergoing open-heart surgery has not been clarified in previous studies. 13,15,16 We hypothesized that MUF accelerates the recovery in neonates undergoing open-heart surgery by early recovery of hemodynamics and pulmonary function and by attenuation of capillary leakage, thereby contributing to our 'fast-track' strategy. To test our hypothesis, we analyzed patients with TGA-IAS and TGA-VSD who underwent ASO with or without MUF because of relative homogeneity of the patients' characteristics, standardized surgical procedure, low operative mortality, and favorable early and long-term hemodynamic results, 17,18 providing a better picture of impacts of MUF on early clinical outcomes in neonatal patients. MethodsWe conducted a retrospective study of neonates who underwent ASO from April 1998 to September 2006 at Okayama University Hospital. The Institutional Review

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Modified Ultrafiltration on Postoperative Course in Neonates With Complete Transposition of the Great Arteries Undergoing Arterial Switch Operation

Kotani

Honjo

Osaki

et al. 2008

Circ J

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“…[1][2][3][4] However, there are no reports about the relationship between the change in the levels of several cytokines and PF drainage after cardiac operation under CPB. We consider that the peritoneal cavity is the largest reservoir of proinflammatory cytokines in the body, 12 and the present study was designed to confirm our hypothesis that PF drainage is useful for quickly improving the patient's condition by reducing proinflammatory cytokines in vivo, which is directly translated into an improvement in clinical outcome.…”

Section: Circulation Journal Vol71 June 2007mentioning

confidence: 77%

“…The white blood cell (WBC) count and C-reactive protein (CRP) levels were followed at the same time. The serum levels of the cytokines in the control group were measured only in the last 3 patients (nos [11][12][13].…”

Section: Measurementsmentioning

confidence: 99%

Significance of Peritoneal Fluid Drainage in Management After Repair of Complex Heart Defects in Infancy Cytokine Dynamics In Vivo

Kurobe

Kitaichi

Shimahara

et al. 2007

Circ J

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“…In some centers, peritoneal drainage catheters are used as adjuncts to traditional methods of mitigating postoperative fluid overload in this patient population [4][5][6][7][8][9]. These catheters are typically placed intraoperatively and are allowed to drain passively to gravity, acting as an additional means of removing unwanted extravascular fluid.…”

Section: Introductionmentioning

confidence: 99%

Peritoneal Drainage Versus Pleural Drainage After Pediatric Cardiac Surgery

Gowda

Zidan

Walters

et al. 2014

World J Pediatr Congenit Heart Surg

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Background: 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. Methods: 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. Results: 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, À41 + 53 mL/kg in patients with periteonal drainage and À9 + 40 mL/kg in patients with pleural drainage (P ¼ .10). At 72 hours however, postoperative fluid balance was significantly more negative with peritoneal drainage, À52.4 + 71.6 versus þ2.0 + 50.6 (P ¼ .04). On subset analysis, fluid balance at 48 hours in patients with AVSD was more negative with peritoneal drainage as compared to pleural, À82 + 51 versus À1 + 38 mL/kg, respectively (P ¼ .02). Fluid balance at 48 hours in patients with TOF was not significantly different between study groups. Conclusion: 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.

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Do peritoneal catheters remove pro-inflammatory cytokines after cardiopulmonary bypass in neonates?

Cited by 72 publications

References 18 publications

Effect of Modified Ultrafiltration on Postoperative Course in Neonates With Complete Transposition of the Great Arteries Undergoing Arterial Switch Operation

Effect of Modified Ultrafiltration on Postoperative Course in Neonates With Complete Transposition of the Great Arteries Undergoing Arterial Switch Operation

Significance of Peritoneal Fluid Drainage in Management After Repair of Complex Heart Defects in Infancy Cytokine Dynamics In Vivo

Peritoneal Drainage Versus Pleural Drainage After Pediatric Cardiac Surgery

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