Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery. Effects on hemostasis, cytokines, and complement components.

摘要: BACKGROUND This prospective study was intended to determine in a homogeneous population of children whether hemofiltration, performed during cardiopulmonary bypass rewarming, is able improve hemodynamics and biologic hemostasis variables, reduce postoperative blood loss, time extubation, plasma cytokines, complement fragments. METHODS Thirty-two undergoing surgical correction tetralogy Fallot were randomly assigned hemofiltration or control group. Hemofiltration with polysulphone hemofilter rewarming bypass. Plasma clotting factors, D-dimers, antithrombin-III, fragments C3a C5a, interleukin-1 beta, interleukin-6, interleukin-8, tumor necrosis factor-alpha measured before after hemofiltration. Systemic mean arterial pressure, left atrial loss monitored. RESULTS In the group, significant reductions 24-h (250 (176-356) vs. 319 (182-500) ml/m2, median (minimum-maximum), extubation (15 (9-22) 19 (11-24) h), concentrations C3a, observed compared control. Arterial oxygen tension on admission intensive care unit significantly greater group (136 +/- 20 103 25 mmHg, SD). Significant increases antithrombin-III noted for No intergroup difference platelets count, duration stay unit. CONCLUSIONS improves early oxygenation reduces mechanical ventilation. remove some major mediators inflammatory response.