Peritoneal Drainage Versus Pleural Drainage After Pediatric Cardiac Surgery

Abstract

Background: We aimed to determine whether infants undergoing cardiac surgery would more efficiently attain negative fluid balance postoperatively with passive peritoneal drainage as compared to traditional pleural drainage. Methods: A prospective, randomized study including children undergoing repair of tetralogy of Fallot (TOF) or atrioventricular septal defect (AVSD) was completed between September 2011 and June 2013. Patients were randomized to intraoperative placement of peritoneal catheter or right pleural tube in addition to the requisite mediastinal tube. The primary outcome measure was fluid balance at 48 hours postoperatively. Variables were compared using t tests or Fisher exact tests as appropriate. Results: A total of 24 patients were enrolled (14 TOF and 10 AVSD), with 12 patients in each study group. Mean fluid balance at 48 hours was not significantly different between study groups, À41 + 53 mL/kg in patients with periteonal drainage and À9 + 40 mL/kg in patients with pleural drainage (P ¼ .10). At 72 hours however, postoperative fluid balance was significantly more negative with peritoneal drainage, À52.4 + 71.6 versus þ2.0 + 50.6 (P ¼ .04). On subset analysis, fluid balance at 48 hours in patients with AVSD was more negative with peritoneal drainage as compared to pleural, À82 + 51 versus À1 + 38 mL/kg, respectively (P ¼ .02). Fluid balance at 48 hours in patients with TOF was not significantly different between study groups. Conclusion: Passive peritoneal drainage may more effectively facilitate negative fluid balance when compared to pleural drainage after pediatric cardiac surgery, although this benefit is not likely universal but rather dependent on the patient's underlying physiology.

Prophylactic Peritoneal Catheter Placement in Congenital Cardiac Surgery

“…5,6 A study of patients with atrioventricular septal defect (AVSD) or tetralogy of Fallot (TOF) showed that AVSD patients with peritoneal catheters achieved a negative fluid balance significantly faster than those without. 7 In contrast, no significant differences were observed in TOF patients. 7 These results suggest that the benefit of a peritoneal catheter may not be universal but dependent on patients' underlying physiology.…”

“…7 In contrast, no significant differences were observed in TOF patients. 7 These results suggest that the benefit of a peritoneal catheter may not be universal but dependent on patients' underlying physiology. One patient in that study required surgical revision because of a small colonic perforation by the peritoneal catheter, which prolonged hospital stay.…”

“…One patient in that study required surgical revision because of a small colonic perforation by the peritoneal catheter, which prolonged hospital stay. 7 In a separate study of Fontan patients, the peritoneal catheter group needed significantly less time to achieve negative fluid balance. 8 The Fontan patients with peritoneal catheter also required longer mechanical ventilation.…”

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

“…Retrospective studies in children recovering from selected cardiac operations have found an association between peritoneal drainage and shorter time to negative fluid balance and extubation (48,60,61). Intraoperative or early postoperative placement of a peritoneal drain may be more prudent than awaiting the development of renal failure (62,63).…”

Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

“…We completed full-text review of 17 studies (13-29), including 4 RCTs (17,20,25,26) (29). Eleven studies were from North America (14,16,17,(19)(20)(21)(23)(24)(25)(26)(27), three from Europe (13,15,28), and three from Asia (18,22,29).…”