Modified ultrafiltration after cardiopulmonary bypass in pediatric cardiac surgery

Background. Cardiopulmonary bypass in children results in considerable water retention, especially in neonates and small infants. Dilution of plasma proteins increases water loss into the extravascular compartments. Excessive total body water may prolong ventilatory support and may contribute to a prolongation of intensive care convalescence, After discontinuation of cardiopulmonary bypass, modified ultrafiltration can be used to withdraw plasma water from the total circulating volume. Methods. This retrospective study included 198 pediatric patients who underwent cardiac operations in the period from September 1991 to November 1994. Two groups were compared: 99 patients without ultrafiltration and 99 patients receiving modified ultrafiltration. The following indices were analyzed: cardiopulmonary bypass prime volume, transfused blood volume during and after the operation, postoperative chest drain loss, and hemoglobin and hematocrit levels before, during, and after the procedure. Results. Modified ultrafiltration resulted in a significant increase in hemoglobin and hematocrit levels and a significantly lower amount of transfused blood. Mean postoperative chest drain loss was significantly less in the patients who underwent modified ultrafiltration. Conclusions. Modified ultrafiltration decreases blood transfusion requirements and chest drain loss after pediatric cardiac surgical procedures. (C) 1997 by The Society of Thoracic Surgeons.