Use of Peripheral Ultrafiltration in the Postoperative Cardiac Surgery Patient

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> After cardiac surgery, most patients have development of third-space fluid retention, commonly treated with diuretics. In some patients diuretics are ineffective. In this subset, a simplified system for ultrafiltration was used for fluid extraction. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> After obtaining permission from the institutional review board, the hospital charts of the first 30 patients having ultrafiltration were retrospectively reviewed to abstract data on fluid extraction and patient outcomes. Data are expressed as mean ± standard deviation. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> From April 2004 through January 2006, 30 patients were selected for ultrafiltration. In one patient, adequate intravenous access could not be obtained. There were 11 female and 18 male (age, 69 ± 12 years) postoperative cardiac surgery patients. The mean ultrafiltration run was 10.5 ± 9 hours, resulting in fluid extraction of 3528 ± 2111 mL per run and 5596 ± 3870 mL per patient (11 patients had more than 1 run). Hospital stay was 9.4 ± 4.4 days. Three patients died unrelated to ultrafiltration. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Ultrafiltration as an alternative means of fluid extraction in postoperative cardiac surgery patients was effective and well tolerated. </jats:p></jats:sec>

Use of the Aquadex™ system for ultrafiltration therapy in a hemodynamically unstable pediatric patient

“…The mechanism of ultrafiltration is by convection, eliminating iso-osmolar extracellular fluid, and hence avoiding the potential electrolyte abnormalities, such as hypomagnesemia, which is associated with other types of fluid removal modalities (Fig. 3) [1,9]. This was a potential benefit in our patient, who had refractory arrhythmias.…”

“…Similarly, ultrafiltration membranes, such as the one that is used in the Aquadex™ system, allow passage of small molecules, including pro-inflammatory cytokines that may cause myocardial depression and are implicated in the systemic inflammatory response that is observed in infants and children after congenital heart surgery [6,11]. We speculate that removal of these substances by ultrafiltration in the post-operative period may have contributed to the overall improvement in our patient's clinical status and multiorgan dysfunction [1,[6][7][8][9]11].…”

“…Fluid overload in the early postoperative period after pediatric cardiac surgery is a well described phenomenon that is independently associated with increased morbidity and mortality [1][2][3][4][5]. Factors contributing to this process include low cardiac output syndrome and systemic inflammatory response after cardiopulmonary bypass, due to reperfusion injury with ischemia, oxidative stress, and release of antidiuretic hormone.…”

“…Since the 1980s, ultrafiltration has been used as an alternative mechanism of fluid removal in adult patients with congestive heart failure [6]. Numerous clinical trials have demonstrated advanced ultrafiltration devices, such as the Aquadex™ system, to be safe and effective, while maintaining hemodynamic stability, avoiding global electrolyte imbalance, and achieving symptomatic relief of congestive heart failure [1,[6][7][8][9]. The less invasive, low flow capability of this type ultrafiltration makes it an attractive option for fluid removal in patients who may not be stable enough to tolerate other more invasive means of fluid removal, such as continuous veno-venous hemofiltration (CVVH).…”

Incorporating Aquapheresis™ into the Hospital Setting: A Practical Approach

“…6,7,11 However, only Aquapheresis TM provides the option of peripheral access as well as delivery outside critical care or dialysis units. [11][12][13] The UNLOAD study was a prospective randomized clinical trail specific to Aquapheresis TM . One hundred patients with evidence of volume overload received intravenous (IV) diuretics (either by a bolus or a continuous infusion) at a dose at least twice the home oral dose.…”