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Ulrich EH, Bedi PK, Alobaidi R, Morgan CJ, Paulden M, Zappitelli M, Bagshaw SM. Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. Pediatr Crit Care Med 2024; 25:e291-e302. [PMID: 38334438 DOI: 10.1097/pcc.0000000000003465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The objective of this Prospective Register of Systematic Reviews (CRD42022384192) registered systematic review and meta-analysis was to determine whether prophylactic peritoneal dialysis (PD) catheter insertion at the time of pediatric cardiac surgery is associated with improved short-term outcomes. DATA SOURCES Databases search of the MEDLINE, EMBASE, CINAHL, and Cochrane Library completed in April 2021 and updated October 2023. STUDY SELECTION Two reviewers independently completed study selection, data extraction, and bias assessment. Inclusion criteria were randomized controlled trials (RCTs) and observational studies of children (≤ 18 yr) undergoing cardiac surgery with cardiopulmonary bypass. We evaluated use of prophylactic PD catheter versus not. DATA EXTRACTION The primary outcome was in-hospital mortality, as well as secondary short-term outcomes. Pooled random-effect meta-analysis odds ratio with 95% CI are reported. DATA SYNTHESIS Seventeen studies met inclusion criteria, including four RCTs. The non-PD catheter group received supportive care that included diuretics and late placement of PD catheters in the ICU. Most study populations included children younger than 1 year and weight less than 10 kg. Cardiac surgery was most commonly used for arterial switch operation. In-hospital mortality was reported in 13 studies; pooled analysis showed no association between prophylactic PD catheter placement and in-hospital mortality. There were mixed results for ICU length of stay and time to negative fluid balance, with some studies showing shortened duration associated with use of prophylactic PD catheter insertion and others showing no difference. Overall, the studies had high risk for bias, mainly due to small sample size and lack of generalizability. CONCLUSIONS In this meta-analysis, we have failed to demonstrate an association between prophylactic PD catheter insertion in children and infants undergoing cardiac surgery and reduced in-hospital mortality. Other relevant short-term outcomes, including markers of fluid overload, require further study.
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Affiliation(s)
- Emma H Ulrich
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Prabhjot K Bedi
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Rashid Alobaidi
- Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Morgan
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mike Paulden
- Health Economics, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael Zappitelli
- Division of Pediatric Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
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Rivera-Figueroa E, Ansari MAYM, Mallory ET, Garg P, Onder AM. Predictors of early peritoneal dialysis initiation in newborns and young infants following cardiac surgery. Cardiol Young 2024:1-8. [PMID: 38163994 DOI: 10.1017/s1047951123004286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This single-centre, retrospective cohort study was conducted to investigate the predictors of early peritoneal dialysis initiation in newborns and young infants undergoing cardiac surgery. METHODS There were fifty-seven newborns and young infants. All subjects received peritoneal dialysis catheter after completion of the cardiopulmonary bypass. Worsening post-operative (post-op) positive fluid balance and oliguria (<1 ml/kg/hour) despite furosemide were the clinical indications to start early peritoneal dialysis (peritoneal dialysis +). Demographic, clinical, and laboratory data were collected from the pre-operative, intra-operative, and immediately post-operative periods. RESULTS Baseline demographic data were indifferent except that peritoneal dialysis + group had more newborns. Pre-operative serum creatinine was higher for peritoneal dialysis + group (p = 0.025). Peritoneal dialysis + group had longer cardiopulmonary bypass time (p = 0.044), longer aorta cross-clamp time (p = 0.044), and less urine output during post-op 24 hours (p = 0.008). In the univariate logistic regression model, pre-op serum creatinine was significantly associated with higher odds of being in peritoneal dialysis + (p = 0.021) and post-op systolic blood pressure (p = 0.018) and post-op mean arterial pressure (p=0.001) were significantly associated with reduced odds of being in peritoneal dialysis + (p = 0.018 and p = 0.001, respectively). Post-op mean arterial pressure showed a statistically significant association adjusted odds ratio = 0.89, 95% confidence interval [0.81, 0.96], p = 0.004) with peritoneal dialysis + in multivariate analysis after adjusting for age at surgery. CONCLUSIONS In our single-centre cohort, pre-op serum creatinine, post-op systolic blood pressure, and mean arterial pressure demonstrated statistically significant association with peritoneal dialysis +. This finding may help to better risk stratify newborns and young infants for early peritoneal dialysis start following cardiac surgery.
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Affiliation(s)
- Elvia Rivera-Figueroa
- Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, MS, USA
- Division of Pediatric Critical Care, Puerto Rico Women's and Children's Hospital, Ponce Health Sciences University, Bayamon, Puerto Rico
| | - Md Abu Yusuf M Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Padma Garg
- Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, MS, USA
| | - Ali Mirza Onder
- Division of Pediatric Nephrology, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, MS, USA
- Division of Pediatric Nephrology, Nemours Children's Health, Wilmington, DE, USA
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Arslan AH, Aksoy T, Ugur M, Ustunsoy H. Factors affecting the clinical outcomes in pediatric post-cardiotomy patients requiring perioperative peritoneal dialysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:627-631. [PMID: 35584486 DOI: 10.1590/1806-9282.20211279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Fluid overload is associated with increased mortality and morbidity in pediatric cardiac surgery. In the pediatric age group, peritoneal dialysis might improve postoperative outcome with avoiding fluid overload and electrolyte imbalance. It preserves hemodynamic status with the advantage of passive drainage. In this study, we are reporting our results of peritoneal dialysis after cardiac surgery. METHODS In this retrospective study, we evaluated the patients who underwent pediatric cardiac surgery in our hospital between December 2010 and January 2020. Patients who required peritoneal dialysis during hospitalization period were included in the study. Patients' clinical status and outcomes were evaluated. RESULTS Peritoneal dialysis was performed to 89 patients during the study period. The age varies from the newborn to 4 years old. The indication of peritoneal dialysis was prophylactic in 68.5% (n=61) and for the treatment in 31.5% (n=28). There were 31 mortalities. The risk factors for the mortality were preoperative lower age, longer cardiopulmonary bypass time, lengthened intubation, lengthened inotropic support, and requirement of extracorporeal membrane oxygenation (p<0.0001). CONCLUSION Earlier initiation of peritoneal dialysis in pediatric cardiac surgery helps maintain hemodynamic instability by avoiding fluid overload, considering the difficulty in the treatment of electrolyte imbalance and diuresis.
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Affiliation(s)
- Ahmet Hulisi Arslan
- Anadolu Medical Center, Department of Cardiovascular Surgery - Kocaeli, Turkey
| | - Tamer Aksoy
- Anadolu Medical Center, Department of Anesthesiology and Reanimation - Kocaeli, Turkey
| | - Murat Ugur
- University of Health Sciences, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, Department of Cardiovascular Surgery - Istanbul, Turkey
| | - Hasim Ustunsoy
- Anadolu Medical Center, Department of Cardiovascular Surgery - Kocaeli, Turkey
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Rutledge A, Murphy HJ, Harer MW, Jetton JG. Fluid Balance in the Critically Ill Child Section: "How Bad Is Fluid in Neonates?". Front Pediatr 2021; 9:651458. [PMID: 33959572 PMCID: PMC8093499 DOI: 10.3389/fped.2021.651458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022] Open
Abstract
Fluid overload (FO) in neonates is understudied, and its management requires nuanced care and an understanding of the complexity of neonatal fluid dynamics. Recent studies suggest neonates are susceptible to developing FO, and neonatal fluid balance is impacted by multiple factors including functional renal immaturity in the newborn period, physiologic postnatal diuresis and weight loss, and pathologies that require fluid administration. FO also has a deleterious impact on other organ systems, particularly the lung, and appears to impact survival. However, assessing fluid balance in the postnatal period can be challenging, particularly in extremely low birth weight infants (ELBWs), given the confounding role of maternal serum creatinine (Scr), physiologic weight changes, insensible losses that can be difficult to quantify, and difficulty in obtaining accurate intake and output measurements given mixed diaper output. Although significant FO may be an indication for kidney replacement therapy (KRT) in older children and adults, KRT may not be technically feasible in the smallest infants and much remains to be learned about optimal KRT utilization in neonates. This article, though not a meta-analysis or systematic review, presents a comprehensive review of the current evidence describing the effects of FO on outcomes in neonates and highlights areas where additional research is needed.
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Affiliation(s)
- Austin Rutledge
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Heidi J Murphy
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Matthew W Harer
- Department of Pediatrics (Neonatology), University of Wisconsin, Madison, WI, United States
| | - Jennifer G Jetton
- Stead Family Department of Pediatrics (Nephrology), University of Iowa Health Care, Iowa City, IA, United States
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Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis. Pediatr Nephrol 2020; 35:1109-1119. [PMID: 32040627 DOI: 10.1007/s00467-020-04489-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/07/2019] [Accepted: 01/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pediatric cardiac surgery is commonly associated with acute kidney injury (AKI) and significant fluid retention, which complicate postoperative management and lead to increased rates of morbidity. This meta-analysis aimed to accumulate current literature evidence and evaluate the correlation of fluid overload degree with adverse outcome in patients undergoing congenital heart surgery. METHODS Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically searched from inception. All studies reporting the effects of fluid overload on postoperative clinical outcomes were selected. A dose-response meta-analytic method using restricted cubic splines was implemented in R-3.6.1. RESULTS Twelve studies were included, with a total of 3111 pediatric patients. Qualitative synthesis indicated that fluid overload was linked to significantly higher risk of mortality, AKI, prolonged hospital, and intensive care unit (ICU) stay, as well as with increased duration of mechanical ventilation, inotrope need, and infection rate. Meta-analysis demonstrated a linear correlation between fluid overload and the risk of mortality (χ2 = 6.22, p value = 0.01) and AKI (χ2 = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ2 = 18.84, p value = 0.0001) and ICU stay (χ2 = 63.69, p value = 0.0001). CONCLUSIONS The present meta-analysis supports that postoperative fluid overload is significantly linked to elevated risk of prolonged hospital stay, AKI development, and mortality in pediatric patients undergoing cardiac surgery. These findings warrant replication by future prospective studies, which should define the optimal cutoff values and assess the effectiveness of therapeutic strategies to limit fluid overload in the postoperative setting.
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Abstract
BACKGROUND The management of fluid overload after congenital heart surgery has been limited to diuretics, fluid restriction, and dialysis. This study was conducted to determine the association between peritoneal dialysis and important clinical outcomes in children undergoing congenital heart surgery. METHODS A retrospective review was conducted to identify patients under 18 years of age who underwent congenital heart surgery. The data were obtained over a 16-year period (1997-2012) from the Kids' Inpatient Database. Data analysed consisted of demographics, diagnoses, type of congenital heart surgery, length of stay, cost of hospitalisation, and mortality. Logistic regression was performed to determine factors associated with peritoneal dialysis. RESULTS A total of 46,176 admissions after congenital heart surgery were included in the study. Of those, 181 (0.4%) utilised peritoneal dialysis. The mean age of the peritoneal dialysis group was 7.6 months compared to 39.6 months in those without peritoneal dialysis. The most common CHDs were atrial septal defect (37%), ventricular septal defect (32.6%), and hypoplastic left heart syndrome (18.8%). Univariate analyses demonstrated significantly greater length of stay, cost of admission, and mortality in those with peritoneal dialysis. Regression analyses demonstrated that peritoneal dialysis was independently associated with significant decrease in cost of admission (-$57,500) and significant increase in mortality (odds ratio 1.5). CONCLUSIONS Peritoneal dialysis appears to be used in specific patient subsets and is independently associated with decreased cost of stay, although it is associated with increased mortality. Further studies are needed to describe risks and benefit of peritoneal dialysis in this population.
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