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J Thorac Cardiovasc Surg 2001;122:209-211
© 2001 The American Association for Thoracic Surgery

Editorials

Use of ultrafiltration during and after cardiopulmonary bypass in children

From the Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.

Received for publication March 12, 2001. Accepted for publication March 20, 2001. Address for reprints: J. William Gaynor, MD, Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia PA 19104 (E-mail: gaynor@email.chop.edu).

See related article on page 220.

Improvements in the technology of cardiopulmonary bypass (CPB) have significantly reduced morbidity after repair of complex congenital heart defects, even in very small neonates. Use of CPB, however, may expose infants to extremes of hemodilution and hypothermia, often in association with tissue ischemia, as well as initiate a systemic inflammatory response with significant accumulation of excess body water. Organ dysfunction after CPB, especially the heart, lungs, and brain, may result in significant postoperative morbidity and mortality. A variety of techniques have been developed to reverse the increase in total body water (TBW) after CPB, including ultrafiltration during CPB, postoperative peritoneal dialysis, postoperative continuous arteriovenous hemofiltration, and aggressive use of diuretics postoperatively. Ultrafiltration is a technique that removes plasma water and low molecular weight solutes by a convective process using hydrostatic forces across a semipermeable membrane. The composition of the ultrafiltrate is dependent on the pore size of the hemofilter. Ultrafiltration was initially used during CPB, usually during rewarming (conventional ultrafiltration or CUF). The volume of filtrate that can be removed during CUF is restricted by the volume of the venous reservoir, and thus CUF provides only a limited ability to remove excess water and reverse hemodilution.

Because of dissatisfaction with the ability of CUF to consistently prevent the increase in TBW and reverse hemodilution after CPB in infants, Naik, Knight and Elliott ^1,2 introduced a technique of ultrafiltration after separation from CPB, which they termed modified ultrafiltration (MUF). In a preliminary study, they compared the efficacy of no ultrafiltration, CUF, and MUF in preventing accumulation of excess TBW. ¹ Changes in TBW were monitored by bioelectric impedance. The volume of filtrate that could be removed during MUF was significantly greater than during CUF. MUF significantly reduced the postoperative increase in TBW, whereas results with CUF . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2001 122: 220-228. [Abstract] [Full Text] [PDF]

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