Kwiatkowski David M, Alten Jeffrey A, Mah Kenneth E, Selewski David T, Raymond Tia T, Afonso Natasha S, Blinder Joshua J, Coghill Matthew T, Cooper David S, Koch Joshua D, Krawczeski Catherine D, Morales David L S, Neumayr Tara M, Rahman A K M Fazlur, Reichle Garrett, Tabbutt Sarah, Webb Tennille N, Borasino Santiago
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
JTCVS Open. 2024 Mar 25;19:275-295. doi: 10.1016/j.xjon.2024.03.009. eCollection 2024 Jun.
The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.
This propensity score-matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.
Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.
This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.
本研究旨在确定在接受体外循环高风险心脏手术的新生儿中，术中放置腹膜导管是否与改善预后相关。
这项倾向评分匹配的回顾性研究使用了来自22个学术性儿科心脏重症监护病房的数据。对参与新生儿和儿科心脏肾脏结局网络合作项目的中心中，连续接受胸外科医师协会-欧洲心胸外科协会3至5级心脏手术并进行体外循环的新生儿进行研究，以确定术中放置腹膜导管用于透析或被动引流与临床结局（包括机械通气时间）之间的关联。
在新生儿和儿科心脏肾脏结局网络数据集中的1490例符合条件的新生儿中，采用倾向匹配分析比较了395例放置腹膜导管的患者和628例未放置腹膜导管的患者。拔管时间和大多数临床结局相似。放置腹膜导管组的术后住院时间长5天（17天对22天，P = 0.001）。未放置腹膜导管组中重度急性肾损伤的发生率高50%（12%对18%，P = 0.02）。特定治疗之间以及高危患者中的亚组分析得出了相似的关联。
本研究未证明心脏手术期间放置腹膜导管的新生儿预后得到改善。除了放置腹膜导管组住院时间较长外，结局相似。未放置腹膜导管组中重度急性肾损伤的发生率高50%（12%对18%）。尽管该分析可能支持在有急性肾损伤风险的新生儿中使用腹膜导管进行术后液体清除，但不支持不加区别地使用腹膜导管。多中心对照试验可能能更好地阐明腹膜导管的作用。
