Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery

Zaccaria Ricci, Angelo Polito, Roberta Netto, Francesca De Razza, Isabella Favia, Adriano Carotti, Paola E. Cogo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Modified ultrafiltration is commonly used in pediatric cardiac surgery. Although its clinical benefits are currently debated, modified ultrafiltration has proved to improve mean arterial pressure in the first postoperative hours. Aim of our study was to measure cardiac index, stroke volume index, and mean arterial pressure modification before and after modified ultrafiltration by means of Pressure Recording Analytical Method. Design: Single-center prospective observational cohort study. Setting: Pediatric cardiac surgery operating room. Patients: Children below 20 kg that are included in the "pediatric" mode of Pressure Recording Analytical Method. Measurements and main results: Forty patients were enrolled in this study. Median age, weight, and body surface area at surgery were 3 months (interquartile range, 10 days to 3.5 yr), 5.6 (3.1-15) kg, and 0.31 (0.21-0.56), respectively. During the modified ultrafiltration procedure, a median volume of 17 mL/kg (11-25) was ultrafiltered and a median volume of 11 mL/kg (6-17) was reinfused with a median final modified ultrafiltration balance of -0.15 mL/kg (-4.0 to 0.1). By univariate analyses, there was a 10% increase in postmodified ultrafiltration mean, systolic and diastolic pressures (p = 0.01), stroke volume index (p = 0.02), and cardiac index (p = 0.001) without significant changes in heart rate, central (left and right) venous pressures, stroke volume variation, and inotropic score. By multivariate analysis, when controlling for cardiopulmonary bypass time and age at surgery, cardiac index variation was independently associated with lower preoperative body surface area (beta coefficient -5.5, p = 0.04). Conclusions: According to Pressure Recording Analytical Method assessment, modified ultrafiltration acutely improves myocardial function, as shown by a 10% increase of systemic arterial pressure, stroke volume index, and cardiac index. This effect is more pronounced in smaller sized patients.

Original languageEnglish
Pages (from-to)390-395
Number of pages6
JournalPediatric Critical Care Medicine
Volume14
Issue number4
DOIs
Publication statusPublished - May 2013

Keywords

  • Cardiac output
  • Cardiopulmonary bypass
  • Congenital heart disease
  • Modified ultrafiltration
  • Pediatric cardiac surgery
  • Pulse contour monitoring

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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