Patients requiring
cardiopulmonary bypass for congenital heart surgery commonly exhibit impaired renal function and extravascular fluid retention. These conditions contribute to early postoperative fluid overload, which may result in significant morbidity and mortality. We examined the safety and efficacy of
peritoneal dialysis in removing extravascular fluid from
critically ill postcardiotomy patients. A retrospective case review from July of 1995 through April of 1996 was conducted. All patients undergoing
peritoneal dialysis achieved a net negative fluid balance. Average urine output increased from 2.1 cc/kg/hr to 3.9 cc/kg/hr (P < 0.01) during the pre-
peritoneal dialysis to post-
peritoneal dialysis period, and the mean number of inotropic agents decreased from 2.2 to 1.7 (P < 0.05). Controlled comparison revealed that the
peritoneal dialysis cohort more rapidly achieved a negative weight-adjusted fluid balance throughout the early postoperative course. The
peritoneal dialysis group's illness severity decreased more rapidly within the 24-hour period after initiation of
peritoneal dialysis than did that of the control cohort over the same period of time. No difference in postoperative morbidity or mortality existed between the study groups. Complications from the
catheter placement were minimal, and no patient experienced
peritonitis or metabolic or hemodynamic instability during
peritoneal dialysis catheter placement, usage, or removal.
Peritoneal dialysis is a safe and effective form of
renal replacement therapy, even among
critically ill pediatric postcardiotomy patients. Early postsurgical institution of
peritoneal dialysis may hasten early postoperative recovery. We speculate that intraoperative
catheter placement reduces the complication rate associated with this treatment modality.