Venoarterial modified ultrafiltration versus conventional arteriovenous modified ultrafiltration during cardiopulmonary bypass surgery

Abstract

BACKGROUND AND OBJECTIVESDifferent types of modified ultrafiltration (MUF) systems evaluated showed that none of the MUF techniques adhered to the normal venous to arterial blood flow dynamics. This study compared a conventional arteriovenous modified ultrafiltration (AVMUF) system to a custom-designed venoarterial modified ultrafiltration (VAMUF) system.DESIGN AND SETTINGSRandomized, controlled clinical study conducted at the Northwest Armed Forces Military hospital in Tabuk, Saudi Arabia.PATIENTS AND METHODSSixty patients who underwent MUF during the years 2007 and 2009 were divided into 2 groups: the AVMUF (n=30) and the VAMUF (n=30) groups. MUF was performed for a mean time of 12 minutes in both groups. In AVMUF, blood was removed from the aorta, hemoconcentrated, and infused into the right atrium (RA). In VAMUF, blood flow was from the RA through a hemoconcentrator and re-infused into the aorta.RESULTSResults of the study showed that the VAMUF group required a shorter ventilation time (P<.001), intensive care unit (ICU) (P=.003), and hospital stay (P=.007) than the AVMUF group. Results also demonstrated a lower percentage of fluid balance (P=.008) in the VAMUF group. The systolic (P<.001) and mean blood pressures (P<.001) were significantly higher after VAMUF, with a decrease in heart rate (P<.001) and central venous pressure (P=.002). The VAMUF group showed a significantly greater decrease of creatinine (P<.001), serum lactacte (P<.001), and uric acid (P<.027) over time with no significant differences in oximetry.CONCLUSIONResults prove that VAMUF is a more physiological technique than AVMUF.

The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery

“…and Meliones et al ., reduction in duration of mechanical ventilation may be due to the removal of excess water from the body, especially the lungs, which could improve the lung function more quickly. [ 14 20 ] Beneficial effects of using MUF in reducing the duration of mechanical ventilation and length of stay in the ICU have been pointed out in various studies most of which, similar to the present study, have used CUF and MUF together;[ 21 22 23 24 25 ] nonetheless, only have a limited number of studies using MUF failed to report a significant change in the duration of mechanical ventilation in patients after surgery. [ 4 18 19 ]…”

“…The arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered by patient blood pressure monitoring. [ 14 ] Cardioplegia cannula was linked to the filter outlet and finally blood was returned from the cardioplegia line to the right atrium in MUF method [ Figure 1 ]. Then, protamine with the initial dose 1 mg/kg was administered to patients after the end of MUF and removing the arterial and venous cannulas, and the next doses were prescribed if the ACT was not at the desired levels.…”

“…[ 4 12 13 ] A number of studies have reported no significant improvement in the clinical conditions of patients, in which MUF has been implemented. [ 14 15 16 ] In this study, we aimed to examine the effects of combined CUF and MUF on mechanical ventilation and hemodynamic changes in pediatric cardiac surgery.…”

Effect of Modified Ultrafiltration on Hemodynamics in Pediatric Cardiac Surgery at Armed Forces Institute of Cardiology/ National Institute of Heart Diseases (Afic/Nihd)

“…Because of this technical difference, more fluid can often be removed with MUF than with CUF, assuming that no or minimal additional volume is added to the circuit during CUF. Some studies have investigated the potential advantages of MUF that it is associated with reduced blood loss and lactate levels [12][13][14] . Some studies have supported the use of modified ultrafiltration as it reduces the level of Interleukin-6 which is known as a pro-inflammatory cytokine in the acute phase of inflammation and recommended MUF to be used on pediatric patients as a routine intervention [15][16][17] .…”

“…The results of this study are comparable with our study, but we had observed the effect of modified ultrafiltration after cardiopulmonary bypass in pediatric patients yielding similar results. There are a large number of studies which compared CUF effects with MUF effect however in our study we did not compare the CUF with MUF as the CUF is done according to the attending perfusionist who decide applying or not applying CUF to the patient, taking circulating volume and actual hematocrit at the start of CPB into account, together with assumed results during perfusion 14 . In 2018, Milovanovic et al, compared MUF and CUF and divided the patients into two groups.…”