Venovenous modified ultrafiltration after cardiopulmonary bypass in children: A prospective randomized study

Background: Cardiopulmonary bypass is associated with the production of bot h proinflammatory and anti-inflammatory cytokines, the balance of which lea ds to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified u ltrafiltration is a modification of this technique, which has the potential ly added advantage of eliminating the obligatory left-to-right shunt associ ated with arteriovenous modified ultrafiltration, We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass, Methods : Thirty-eight pediatric patients were randomly assigned to undergo convent ional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12), Perioperative, cardiopulmonary, and cytokine (tumor necr osis factor-a, interleukin-1 beta, interleukin-6, interleukin-8, and interl eukin-10) data were collected for statistical analysis. Results: Compared w ith patients in the conventional ultrafiltration and control groups, patien ts undergoing venovenous modified ultrafiltration had the greatest volume o f ultrafiltrate removed (46.9 +/- 8.4 mL/kg vs 20.1 +/- 5.0 mL/kg and 0 mL/ kg for conventional ultrafiltration and control groups, respectively; P =.0 001), least increase in total body water (1.91% +/- 1.49 % vs 3.90 % +/- 1. 86 % and 8.24% +/- 3.41%; P =.05), greatest rise in hematocrit (39.7% +/- 1 .7% vs 33.8% +/- 2.1% and 29.6% +/- 2.3%; P =.006), and shortest length of hospital stay (4.41 +/- 0.28 days vs 6.69 +/- 1.47 days and 8.38 +/- 1.11 d ays; P =.03, P =.03). Conclusions: Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.