Short-term renal support in postoperative repair of tetralogy of Fallot in the paediatric intensive care unit: can we predict those who need it?

Management of tetralogy of Fallot in the pediatric intensive care unit

Tetralogy of Fallot (ToF) is one of the most common congenital cyanotic heart lesions and can present to a variety of health care professionals, including teams working in pediatric intensive care. Pediatric intensive care teams may care for a child with ToF pre-operatively, peri-operatively, and post-operatively. Each stage of management presents its own unique challenges. In this paper we discuss the role of pediatric intensive care in each stage of management.

Peritoneal Dialysis Vs Diuretics in Children After Congenital Heart Surgery

BACKGROUND

This study sought to evaluate outcomes of patients undergoing congenital heart surgery who underwent peritoneal dialysis (PD) vs a diuretic regimen.

METHODS

This study conducted a comprehensive search in Medline, EMBASE, Scopus, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from the databases' inception through April 24, 2018. Independent reviewers selected studies and extracted data. A random effects meta-analysis was performed to pool the outcomes of interest across studies.

RESULTS

A total of 8 studies (2 prospective studies, 2 randomized clinical trials, and 4 retrospective studies) with 507 patients were included in this review. A total of 204 (40%) patients underwent PD, whereas the remaining patients underwent fluid removal with diuretics. The analyses demonstrated a significantly shorter time of mechanical ventilation in those patients who underwent PD (mean difference, -1.25 days; 95% confidence interval, -2.18 to -0.33; P = .008) and increased odds of mortality (odds ratio, 2.27; 95% confidence interval, 1.13 to 4.56; P = .02) compared with the diuretic group. No differences were identified in terms of incidence of negative fluid balance by postoperative day 1, presence of peritonitis, and intensive care unit length of stay.

CONCLUSIONS

The meta-analysis did not identify differences between the 2 groups with regard to negative fluid balance after postoperative day 1, incidence of peritonitis, or length of intensive care unit stay. There is a need for large, prospective, multicenter studies to evaluate the benefits and complications associated with PD use further in selected children after congenital heart surgery. Because some of the outcomes were present in only 2 studies, results from the pooled analysis may be underpowered.