Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants

Objective: Evaluation:of the acute hemodynamic changes during peritoneal di alysis in patients with low cardiac output syndrome and acute renal failure after open heart surgery. Patients: Three newborns and three infants after corrective surgery of cong enital heart disease with post cardiotomy dialysis, Five of these had an op en thorax during dialysis, Methods: Cardiac output measurements using the thermodilution technique on two consecutive days at four different times during the peritoneal dialysis cycle. Results: We did not find a deterioration of the cardiac index or systemic v ascular resistance measured over two cycles in each of the six patients. Pu lmonary artery pressure rose slightly after instillation of the dialysate s olution in all patients. Changes in central venous pressure and left atrial pressure were not clinically meaningful. In all patients fluid removal by peritoneal dialysis was effective. All five surviving patients recovered re nal function. Conclusions: Peritoneal dialysis can be performed in newborns and infants f ollowing cardiac surgery without causing acute hemodynamic imbalances. An o pen chest may have a significant impact on hemodynamic stability during per itoneal dialysis by blunting any possible negative alterations of increased intraabdominal pressure.