PERITONEAL-DIALYSIS - AN ADJUNCT TO PEDIATRIC POSTCARDIOTOMY FLUID MANAGEMENT

Patients requiring cardiopulmonary bypass for congenital heart surgery commonly exhibit impaired renal function and extravascular fluid rete ntion. These conditions contribute to early postoperative fluid overlo ad which may result in significant morbidity and mortality We examined the safety and efficacy of peritoneal dialysis in removing extravascu lar fluid from critically iii postcardiotomy patients. A retrospective case review from July of 1995 through April of 1996 was conducted. AN patients undergoing peritoneal dialysis achieved a net negative fluid balance. Average urine output increased from 2.1 cc/kg/hr to 3.9 cc/k g/hr (P<0.01) during the pre-peritoneal dialysis to post-peritoneal di alysis period, and the mean number of inotropic agents decreased from 2.2 to 1.7 (P <0.05). Controlled comparison revealed that the peritone al dialysis cohort more rapidly achieved a negative weight-adjusted fl uid balance throughout the early postoperative course. The peritoneal dialysis group's illness severity decreased more rapidly within the 24 -hour period after initiation of peritoneal dialysis than did that of the control cohort over the same period of time. No difference in post operative morbidity or mortality existed between the study groups. Com plications from the catheter placement were minimal, and no patient ex perienced peritonitis or metabolic or hemodynamic instability during p eritoneal dialysis catheter placement, usage, or removal. Peritoneal d ialysis is a safe and effective form of renal replacement therapy even among critically ill pediatric postcardiotomy patients. Early postsur gical institution of peritoneal dialysis may hasten early postoperativ e recovery. We speculate that intraoperative catheter placement reduce s the complication rate associated with this treatment modality.