Effects of combined conventional and modified ultrafiltration in adult patients

Background. Modified ultrafiltration (MUF) improves hemodynamics and postop erative recovery in children. Ultrafiltration (UF) may have similar benefit s in adults. The purpose of this study was to investigate the effects of UF in adult patients. Methods. A total of 40 adult patients undergoing cardiac surgery were rando mized into a study group of conventional UF during bypass + venovenous MUF after bypass and a control group with no UF. Perioperative clinical variabl es, cytokines, and endothelin-1 levels were compared between groups. Results. There was no mortality in either group. The patients in the study group had a greater rise in hematocrit (5.7% +/- 2.4% vs 1.2% +/- 1.9%, p < 0.001), hemoglobin (1.7 +/- 0.8 mg/mL vs 0.5 +/- 0.6 mg/mL, p < 0.0005), a nd platelet levels (27,800 +/- 29,200 vs -9,000 +/- 30970, p < 0.001). Mean arterial blood pressure and CI increased after MUF (from 64.2 +/- 16.9 mm Hg to 72.3 +/- 14.1 mm Hg, p = 0.05, and from 2.4 +/- 0.7 to 2.8 +/- 0.6, p < 0.03, respectively). Postoperative oxygenation was better in the study g roup (alveolo-arterial PO2 tension gradient 74.6 +/- 43.9 mm Hg vs 107.2 +/ - 27.8 mm Hg, p = 0.03). Ultrafiltration reduced postoperative bleeding (52 2.2 +/- 233.4 mi, vs 740 +/- 198.4 mL, p < 0.003). Conclusions. A combination of conventional and modified UF is effective and safe in adult patients undergoing cardiac surgery. Ultrafiltration improve d hemodynamics, hemostatic, and pulmonary functions. We recommend the use o f combined UF in high-risk adult patients. (C) 2001 by The Society of Thora cic Surgeons.