Assessment of Modified Ultrafiltration Hemodynamic Impact by Pressure Recording Analytical Method During Pediatric Cardiac Surgery

Abstract

According to Pressure Recording Analytical Method assessment, modified ultrafiltration acutely improves myocardial function, as shown by a 10% increase of systemic arterial pressure, stroke volume index, and cardiac index. This effect is more pronounced in smaller sized patients.

Pressure recording analytical method and bioreactance for stroke volume index monitoring during pediatric cardiac surgery

“…Data were collected after anesthesia induction, at the end of CPB, before fluid administration and after fluid administration. Overall, median-IQR PRAM SVI values (23 mlÁm À2 , [19][20][21][22][23][24][25][26][27] were significantly higher than bioreactance SVI (15 mlÁm À2 , 12-25, P = 0.0001). Correlation (r 2 ) between the two methods was 0.15 (P = 0.0003).…”

“…Percentage error was 91.7%. Baseline SVI appeared to be similar, but PRAM SVI was systematically greater than bioreactance thereafter, with the highest gap after the fluid loading phase: 13 (12)(13)(14)(15)(16)(17)(18) mlÁm À2 vs. 23 (19)(20)(21)(22)(23)(24)(25) mlÁm À2 , respectively, P = 0.0013. A multivariable regression model showed that a significant independent inverse correlation with patients' body weight predicted the CI difference between the two methods after fluid challenge (b coefficient À0.12, P = 0.013).…”

More Does Not Mean Better

“…Clinical investigations of the use of MUF in children undergoing cardiac surgery have shown many benefits including reduction of fluid overload, reduced inflammatory mediators and complement activation, improved recovery of cardiac, pulmonary, and cerebral function, and reduced postoperative duration of mechanical ventilation and hospitalization (2)(3)(4)(5)(6)(7)(8)(9). In addition, higher hematocrit and improved coagulation in patients receiving MUF reduce the need for postoperative transfusion and bleeding complications (10).…”

Different predictivity of fluid responsiveness by pulse pressure variation in children after surgical repair of ventricular septal defect or tetralogy of Fallot

“…Pressure recording analytical method (PRAM, Vygon, Vytech, Padova, Italy) is a direct systemic hemodynamic monitoring technique based on mathematical analysis of the arterial waveform to derive PPV and other hemodynamic parameters such as stroke volume and cardiac output . It provides plausible value in measuring cardiac output and tracking its changes after fluid infusion in congenital heart disease children …”