'Are Routine Post-discharge Diuretics Necessary After Pediatric Cardiac Surgery?'

Abstract

A prospective, one-armed, safety non-inferiority trial with historical controls was performed at a single-center, quaternary, children's hospital. Inclusion criteria were children aged 3 months-18 years after pediatric cardiac surgery resulting in a two-ventricle repair between 7/2020 and 7/2021. Eligible patients were compared with patients from a 5-year historical period (selected using a database search). The intervention was that "regular risk" patients received no diuretics and pre-specified "high risk" patients received 5 days of twice per day furosemide at discharge. 61 Subjects received the intervention. None were readmitted for pleural effusions, though 1 subject was treated for a symptomatic pleural effusion with outpatient furosemide. The study was halted after an interim analysis demonstrated that 4 subjects were readmitted with pericardial effusion during the study period versus 2 during the historical control (2.9% versus 0.2%, P = 0.003). We found no evidence that limited post-discharge diuretics results in an increase in readmissions for pleural effusions. This conclusion is limited as not enough subjects were enrolled to definitively show that this strategy is not inferior to the historical practice. There was a statistically significant increase in readmissions for pericardial effusions after implementation of this study protocol which can lead to serious complications and requires further study before conclusions can be drawn regarding optimal diuretic regimens.

• Authors: Jamie S Penk, Guilherme Baptista de Faria, Catherine A Collins, Lindsay M Jackson, Avaliese L Porlier, Lucia C Petito, Bradley S Marino
• Journal: Pediatric cardiology (Pediatr Cardiol) Vol. 44 Issue 4 Pg. 915-921 (Apr 2023) ISSN: 1432-1971 [Electronic] United States
• PMID: 36562779 (Publication Type: Equivalence Trial, Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Diuretics
• Furosemide

Topics

• Child
• Humans
• Aftercare
• Cardiac Surgical Procedures (adverse effects, methods)
• Diuretics (therapeutic use)
• Furosemide (therapeutic use)
• Patient Discharge
• Pericardial Effusion (etiology)
• Pleural Effusion (etiology)
• Prospective Studies