Methods of modified ultrafiltration in the surgical correction of transposition of the great arteries in newborns

Abstract

Surgery 270I n the world the number of operations carried out for congenital heart disease (CHD) is increasing each year, including those executed in the neonatal period [1].One of the main intraoperative problems faced by an anesthesiologist and a perfusionist is the violation of child's hydrobalance and its correction. The causes of fluid overload may be the physiological characteristics of children (the physiological hydrophilic of fabric, the imperfection of kidneys functions, as well as their post-operative injury), conducting cardiopulmonary bypass (CB) (the mismatch of the circulating blood volume (CBV) of a child and the primary volume filling the circuit of the CB device, the introduction of exogenous fluids, the incompatibility of the CB circuit materials and the patient's blood, which in turn can trigger an enzyme cascade, which leads to the development of the capillary leak syndrome) [3,15].This pathological condition can be fixed by two methods of ultrafiltration: ultrafiltration (UF) during CB and modified ultrafiltration (MUF) [6,8,9].According to the literature, the positive ultrafiltration effects are: the reduction of myocardial edema, increased blood pressure, decreased heart rate, decreased central venous pressure, reduced need for inotropes [7, 11], improved oxygenation and reduction of extravascular lung water [4,13], decrease in the severity of postperfusion systemic inflammatory response (reduction of plasma levels of proinflammatory cytokines), increased creatinine clearance and decreased total water content in the body [2,10], increased hematocrit (Ht) and coagulation factors in the plasma, thereby -reducing the use of transfusion media [5,12,14].There is an ongoing and intensive study of the use of ultrafiltration in the practice of child cardioanesthesiology. Our interest is to evaluate the effectiveness of ultrafiltration in combination of anesthetic management during the correction of transposition of the great arteries (TGA) in newborns. The purpose of the research is to evaluate the effectiveness of two methods of ultrafiltration in the correction of transposition of the great arteries in newborns. Correction of congenital heart defects in newborns in the cardiopulmonary bypass is accompanied by volumetric fluid overload. To eliminate this pathological condition an ultrafiltration method is used. The article presents the correction analysis of the years 2012-2016 to 20 newborns with transposition of the great arteries with the use of two methods of ultrafiltration during cardiopulmonary bypass: I group (n=10) -ultrafiltration, II group (n=10) -modified ultrafiltration after cardiopulmonary bypass stop. The findings suggest that in the group which underwent a modified ultrafiltration, the inotropic support index, the need for blood transfusion in the immediate postoperative period, the patient's time spent on mechanical ventilation was significantly lower than in the group of children which underwent ultrafiltration. Keywords: transposition of great arteries, ultrafiltration, modif...

Dynamics of total extracellular water of the body during the modification of ultrafiltration after artificial circulation

“…Этот факт, наводит на мысль, что применение МУФ крови у детей, в некоторых случаях, позволяет контролировать выход жидкости во внеклеточное пространство. Последнее, по-видимому, связано с возможностью удерживать величину гематокрита на приемлемых цифрах во время проведения операции [3,4,6,7].…”

“…В Таблице 1 представлены цифровые значения БЭИ, определенные в исследуемых группах на разных этапах операции и в послеоперационном периоде, и дана оценка динамических изменений БЭИ в ответ на проведение МУФ. Полученные нами результаты и данные других исследователей [1,2,4,5] позволяют рекомендовать метод МУФ крови для коррекции нарушений водного обмена у детей при проведении операций на сердце с ИК.…”

Dynamics of total extracellular water of the body during the modification of ultrafiltration after artificial circulation

“…Этот факт, наводит на мысль, что применение МУФ крови у детей, в некоторых случаях, позволяет контролировать выход жидкости во внеклеточное пространство. Последнее, по-видимому, связано с возможностью удерживать величину гематокрита на приемлемых цифрах во время проведения операции [3,4,6,7].…”

“…В Таблице 1 представлены цифровые значения БЭИ, определенные в исследуемых группах на разных этапах операции и в послеоперационном периоде, и дана оценка динамических изменений БЭИ в ответ на проведение МУФ. Полученные нами результаты и данные других исследователей [1,2,4,5] позволяют рекомендовать метод МУФ крови для коррекции нарушений водного обмена у детей при проведении операций на сердце с ИК.…”