Con: Modified Ultrafiltration in Pediatric Cardiac Surgery Is No Longer Necessary

Mejak, Brian; Lawson, D. Scott; Ing, Richard J.

doi:10.1053/j.jvca.2018.11.018

Cited by 8 publications

(15 citation statements)

References 25 publications

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“…[ 4 – 7 ] The CPB circuit sizes were significantly smaller with the technical advances, and priming volumes were minimized now compared with decades ago. [ 8 ]…”

Section: Introductionmentioning

confidence: 99%

Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery

Hu¹,

Chen³

et al. 2021

Medicine

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Background: This meta-analysis was performed to review the effects of the addition of modified ultrafiltration (MUF) and conventional ultrafiltration (CUF) to CUF alone on postoperative hemoglobin, surgical and ultrafiltration data, and postoperative clinical outcomes in pediatric patients undergoing cardiac surgery. Methods: A systematic search was performed to identify randomized controlled clinical trials that compared MUF and CUF combination with CUF alone in pediatric cardiac surgery undergoing cardiopulmonary bypass (CPB) in PubMed, Embase, Cochrane Library, and Web of Science without any language or date limitation in February 2020. For each included trial, the primary outcomes including post-CPB and postoperative hematocrit, surgical and ultrafiltration data, postoperative clinical outcomes including volume of chest tube drainage within 48 hours after surgery and perioperative blood requirement, ventilation support duration, and length of stay day in the intensive care unit (ICU) and hospital were collected and analyzed. The analysis was conducted using STATA version 12.0. Results: A total of 8 trials encompassing 405 patients were included in this analysis. Analysis indicated that MUF + CUF increased the post-CPB hematocrit (Standard mean difference, SMD = 1.85, 95% confidence interval, 95% CI 0.91–2.79). Meanwhile, ultrafiltration volume was higher in CUF+MUF infants than CUF-alone infants (SMD = 1.46, 95% CI 0.51–2.41, P = .003). The clinical outcomes, including postoperative hemodynamic changes, prime volume, blood requirement, chest tube drainage volume, mechanical ventilation duration, and ICU duration, were unclear because of the unstable sensitivity analyses. Conclusions: Beneficial effects of using MUF and CUF for pediatric cardiac surgery, including increase post-CPB hematocrit and ultrafiltration volume when compared with CUF alone. Meanwhile, MUF and CUF did not significantly influence the postoperative hospital stay duration, CPB, and aortic occlusion duration.

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“…[ 4 – 7 ] The CPB circuit sizes were significantly smaller with the technical advances, and priming volumes were minimized now compared with decades ago. [ 8 ]…”

Section: Introductionmentioning

confidence: 99%

Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery

Hu¹,

Chen³

et al. 2021

Medicine

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“…As demonstrated in several randomized controlled studies, 6% hydroxyethyl starch 130/0.4 could be a cost-effective alternative to albumin for CPB priming in pediatric cardiac surgery. [4][5][6] Although we could agree that the evidence in favor of hydroxyethyl starch is not as high, there is also no clear evidence from the literature proving that a balanced crystalloid solution is effective and safe in this population.…”

Section: Priming Cardiopulmonary Bypass In Pediatric Surgery: Commentmentioning

confidence: 74%

“…4 However, studies showing benefits from modified ultrafiltration are all greater than 10 yr old, 4 and it has been shown that modified ultrafiltration is no longer necessary when small circuit sizes and priming volumes are used. 5 In addition, modified ultrafiltration can result in significant complications. 5 We routinely use normothermic CPB with warm blood cardioplegia.…”

Section: Priming Cardiopulmonary Bypass In Pediatric Surgery: Commentmentioning

confidence: 99%

“…5 In addition, modified ultrafiltration can result in significant complications. 5 We routinely use normothermic CPB with warm blood cardioplegia. We therefore do not apply modified ultrafiltration and use conventional ultrafiltration only sporadically.…”

Section: Priming Cardiopulmonary Bypass In Pediatric Surgery: Commentmentioning

confidence: 99%

“…3 Several studies have demonstrated the progressive increase in overlap between internal jugular vein and carotid artery with the incremental head rotation to opposite side. [4][5][6][7] While performing internal jugular vein cannulation, in addition to the Trendelenburg position and use of ultrasound, minimizing head rotation to the contralateral side may help to decrease the incidence of carotid artery puncture and enhance safety. 8…”

Section: Competing Interestsmentioning

confidence: 99%

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Priming Cardiopulmonary Bypass in Pediatric Surgery: Reply

Dieu¹,

Momeni²

2020

Anesthesiology

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CORRESPONDENCE tracheal intubation than adults. Although the American Society of Anesthesiologists (Schaumburg, Illinois; ASA) provides definitions and clinical examples to guide the use of the ASA Physical Status system, Dr. Horvath states correctly that a patient's age is not considered. 3 Dr. Horvath's suggestion of updating the definitions for the ASA Physical Status system for pediatric patients is worthy of discussion. Assigning ASA Physical Status II to healthy infants because of higher rates of adverse events during tracheal intubation might be problematic. First, the purpose of the ASA Physical Status classification system is to communicate the patient's medical comorbidities, not their anesthetic risk. Second, if age were considered a comorbidity then one would have to assign a higher status for patients at both extremes of age, not just infants. Finally, a rapid sequence induction in a child increases the risk of hypoxemia during laryngoscopy, yet ASA Physical Status is not typically adjusted because of a plan for rapid sequence induction. There are many clinical scenarios wherein infants may be classified appropriately as ASA Physical Status I, such as a 3-month-old patient undergoing a circumcision. Although direct laryngoscopy can be challenging in infants, there are alternatives for establishing an airway, including supraglottic airways and video laryngoscopy, that may be less challenging than direct laryngoscopy.

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Comparative evaluation of blood conservation techniques in cardiovascular surgery using multicriteria decision-making methods

Balcioglu¹,

Emegano²,

Uzun

et al. 2023

2023 Advances in Science and Engineering Technology International Conferences (ASET)

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Con: Modified Ultrafiltration in Pediatric Cardiac Surgery Is No Longer Necessary

Cited by 8 publications

References 25 publications

Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery

Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery

Priming Cardiopulmonary Bypass in Pediatric Surgery: Reply

Comparative evaluation of blood conservation techniques in cardiovascular surgery using multicriteria decision-making methods

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