PERITONEAL DIALYSIS FOLLOWING PEDIATRIC OPEN HEART SURGERY

Background. Children undergoing cardiopulmonary bypass (CPB) often demonstrate increased capillary-permeability and accumulation of excess total-body water (TBW), which can lead to multiple~organ failure and death. The management consists of efforts to diminish the circulating inflammatory mediators from CPB include preemptive -therapies to diminish the inflammatory response and Temovals trategies to eliminate. the inflammatory mediators. It has been demonstrated that .peritoneal dialysis is an effective and safe procedure that not only removes excess ototal-body water and pro-inflammatory factors but also improves hemodynamics, pulmonary and renal function. We studied the role of peritoneal dialysis in infants and children undergoingopen-heart surgery at our department.
Methods. Among 1258 pediatric open-heart surgery cases from January 1996 to September 2000 at our center, 64 patients demonstrated indication for peritoneal dialysis. Our criteria of performing peritoneal dialysis were presence of ascites or oliguria. We measured volume of peritoneal -fluid, as wen as negative balance, urine output and gastric fluid every 2 hours. Central venous pressure and other hemodynamic parameters (MAP, HR) were monitored during peritoneal dialysis
Results. Criteria for performing peritoneal dialysis (ascites or oliguria) were found in 64 of 1258 (5.0 %) patients. Diagnosis for 23 patients was VSD with pulmonary hypertension, 14 patients had transposition of the great arteries (TGA), and 11 patients were candidates for total correction of tetralogy of Fallot. Nineteen of sixty-four patients died mostly due to cardiovascular problems (mortality rate 29.6%). The mean interval between the operation and peritoneal catheter insertion was 10.36±5.95 hours. In the first day the volume of negative balance was 69.51 ±11.80mI, which decreased to 19.41 ±5.81 ml on the fifth day. Urine output was 45.83±6.17(ml/kg/24h) on the first day or 3.31±0.6 (ml/kg/h) in the first hours of peritoneal dialysis and improved to 62.91±12.44 on the third day of peritoneal dialysis. CVP was 13.24±2.49 cmH20 and declined to 10.95 ±1.16 two hours following peritoneal catheter insertion. We found no grossly cloudy or bloody peritoneal fluid.
Conclusion. We conclude that peritoneal dialysis is a safe procedure for infants and children after open heart surgery to reduce CPB complications and preventing multiple organ fai