Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study

Mohamed Elayashy, Mai A Madkour, Ahmed Abdelaal Ahmed Mahmoud, Hisham Hosny, Amr Hussein, Ahmed Nabih, Ahmed Lofty, Hamza Mohamed Hamza, Passaint Hassan, Mohamed Wagih, Ahmed Kareem Mohamed, Mohamed Elayashy, Mai A Madkour, Ahmed Abdelaal Ahmed Mahmoud, Hisham Hosny, Amr Hussein, Ahmed Nabih, Ahmed Lofty, Hamza Mohamed Hamza, Passaint Hassan, Mohamed Wagih, Ahmed Kareem Mohamed

Abstract

Background: Increased lung water and the resultant atelectasis are significant pulmonary complications after cardiopulmonary bypass (CPB) in children undergoing cardiac surgery; these complications are observed after CPB than after anaesthesia alone. Ultrafiltration has been shown to decrease total body water and postoperative blood loss and improve the alveolar to arterial oxygen gradient and pulmonary compliance. This study investigated whether conventional ultrafiltration during CPB in paediatric heart surgeries influences post-bypass extravascular lung water (EVLW) assessed by lung ultrasound (LUS).

Methods: This randomized controlled study included 60 patients with congenital heart disease (ASA II-III), aged 1 to 48 months, with a body weight > 3 kg. Conventional ultrafiltration targeting a haematocrit (HCT) level of 28% was performed on the ultrafiltration group, while the control group did not receive ultrafiltration. LUS scores were recorded at baseline and at the end of surgery. The PaO2/FiO2 ratio (arterial oxygen tension divided by the fraction of inspired oxygen), urine output, and haemodynamic parameters were also recorded.

Results: LUS scores were comparable between the two groups both at baseline (p = 0.92) and at the end of surgery (p = 0.95); however, within the same group, the scores at the end of surgery significantly differed from their baseline values in both the ultrafiltration (p = 0.01) and non-ultrafiltration groups (p = 0.02). The baseline PaO2/FiO2 ratio was comparable between both groups. at the end of surgery, The PaO2/FiO2 ratio increased in the ultrafiltration group compared to that in the non-ultrafiltration group, albeit insignificant (p = 0.16). no correlation between the PaO2/FiO2 ratio and LUS score was found at baseline (r = - 0.21, p = 0.31). On the other hand, post-surgical measurements were negatively correlated (r = - 0.41, p = 0.045).

Conclusion: Conventional ultrafiltration did not alter the EVLW when assessed by LUS and oxygenation state. Similarly, ultrafiltration did not affect the urea and creatinine levels, intensive care unit (ICU) stays, ventilation days, or mortality.

Trial registration: Clinicaltrials.gov Identifier: NCT03146143 registered on 29-April-2017.

Keywords: Extravascular lung water; Lung ultrasound; Paediatric cardiac surgery; Ultrafiltration.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram showing the number of patients at each phase of the study
Fig. 2
Fig. 2
LUS score at baseline and at the end of surgery. Values are expressed as the median and IQR
Fig. 3
Fig. 3
PaO2/FiO2 ratio at baseline and at the end of surgery. Values are presented as the mean (SD)
Fig. 4
Fig. 4
Correlation between the PaO2/FiO2 ratio and LUS score at baseline
Fig. 5
Fig. 5
Correlation between the PaO2/FiO2 ratio and LUS score at the end of surgery

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Source: PubMed

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