The effect of modified ultrafiltration on the amount of circulating endotoxins in children undergoing cardiopulmonary bypass

Objective:To determine whether the use of modified ultrafiltration during p ediatric cardiopulmonary bypass (CPB) diminishes the load of circulating en dotoxins. Design: Single-arm prospective observational study. Setting: A university hospital operating room and intensive care unit. Participants: Twenty children undergoing CPB for correction of various cong enital heart diseases. Interventions: The amount of endotoxins in plasma was measured during CPB a nd before and after modified ultrafiltration. The ultrafiltrate was assayed for the presence of endotoxins, Postoperatively, the children were followe d with relevant infectious parameters and cultures, Measurements and Main Results: The amount of endotoxins increased significa ntly during the CPB procedure (from a median of 1.3 ng [range. 0 to 13.7 ng ] to 24.2 ng [range, 2.1 to 75.9 ng]), After termination of CPB, modified u ltrafiltration was shown to lower the amount of circulating endotoxins in b lood (from a median of 24.2 ng [range, 2.1 to 75.4 ng] to 9.0 [range, 0.1 t o 40.6 ng]), The major bulk of this reduction in endotoxin load was retriev ed in the ultrafiltrate (median of 11.9 ng [range, 0 to 12.1 ng]). Conclusion: This study strongly suggests that modified ultrafiltration decr eases the amount of circulating endotoxins in children undergoing cardiac s urgery. Copyright (C) 2000 by W.B. Saunders Company.