Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2019 Feb;20(2):158-165. doi: 10.1097/PCC.0000000000001793.
Early peritoneal dialysis may have a role in modulating the inflammatory response after cardiopulmonary bypass. This study sought to test the effect of early peritoneal dialysis on major adverse events after pediatric cardiac surgery involving cardiopulmonary bypass.
In this observational study, the outcomes in infants post cardiac surgery who received early peritoneal dialysis (within 6 hr of completing cardiopulmonary bypass) were compared with those who received late peritoneal dialysis. The primary outcome was a composite of one or more of cardiac arrest, emergency chest reopening, requirement for extracorporeal membrane oxygenation, or death. Secondary outcomes included duration of mechanical ventilation, length of intensive care, and hospital stay. A propensity score methodology utilizing inverse probability of treatment weighting was used to minimize selection bias due to timing of peritoneal dialysis.
Cardiac ICU, The Royal Children's Hospital, Melbourne, VIC, Australia.
From 2012 to 2015, infants who were commenced on peritoneal dialysis after cardiac surgery were included.
Among 239 eligible infants, 56 (23%) were commenced on early peritoneal dialysis and 183 (77%) on late peritoneal dialysis. At 90 days, early peritoneal dialysis as compared with late peritoneal dialysis was associated with a decreased risk of primary outcome (relative risk, 0.16; 95% CI, 0.05-0.47; p < 0.001 and absolute risk difference, -18.1%; 95% CI, -25.1 to -11.1; p < 0.001). Early peritoneal dialysis was also associated with a decrease in duration of mechanical ventilation and intensive care stay. Among infants with a cardiopulmonary bypass greater than 150 minutes, early peritoneal dialysis was also associated with a survival advantage (relative risk, 0.14; 95% CI, 0.03-0.84; p = 0.03 and absolute risk difference, -7.8; 95% CI, -13.6 to -2; p = 0.008).
Early peritoneal dialysis in infants post cardiac surgery is associated with a decrease in the rate of major adverse events. The role of early peritoneal dialysis warrants the conduct of randomized trials both in high and low-to-middle income countries; any beneficial effects if confirmed have the potential to strongly influence outcomes for children born with congenital heart disease.
早期腹膜透析可能在体外循环后调节炎症反应方面发挥作用。本研究旨在检验儿科体外循环心脏手术后早期腹膜透析对主要不良事件的影响。
在这项观察性研究中，比较了体外循环完成后 6 小时内接受早期腹膜透析（<0.5 天）的心脏手术后婴儿与接受晚期腹膜透析（>0.5 天）的婴儿的术后结果。主要结局是心脏骤停、紧急开胸、需要体外膜氧合或死亡的复合结果。次要结局包括机械通气时间、重症监护时间和住院时间。利用逆概率治疗加权法的倾向评分方法，尽量减少由于腹膜透析时机引起的选择偏倚。
澳大利亚墨尔本皇家儿童医院心脏重症监护病房。
2012 年至 2015 年，心脏手术后开始腹膜透析的婴儿被纳入研究。
在 239 名符合条件的婴儿中，56 名（23%）接受早期腹膜透析，183 名（77%）接受晚期腹膜透析。90 天时，与晚期腹膜透析相比，早期腹膜透析降低了主要结局的风险（相对风险，0.16；95%CI，0.05-0.47；p<0.001，绝对风险差异，-18.1%；95%CI，-25.1 至-11.1；p<0.001）。早期腹膜透析还与机械通气和重症监护时间的缩短有关。在体外循环时间超过 150 分钟的婴儿中，早期腹膜透析也与生存率的提高有关（相对风险，0.14；95%CI，0.03-0.84；p=0.03，绝对风险差异，-7.8%；95%CI，-13.6 至-2.0%；p=0.008）。
心脏手术后婴儿早期腹膜透析与主要不良事件发生率降低有关。腹膜透析的早期应用在高收入和中低收入国家都需要进行随机试验，若证实有效，将有可能对患有先天性心脏病的儿童的结局产生重大影响。
