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Abstract: PO1962

Prophylactic PD Catheter Placement for Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass: Systematic Review with Meta-Analysis

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Ulrich, Emma Heydari, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Bedi, Prabhjot K., The University of Winnipeg, Winnipeg, Manitoba, Canada
  • Alobaidi, Rashid, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Morgan, Catherine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Paulden, Mike, University of Alberta, Edmonton, Alberta, Canada
  • Zappitelli, Michael, University of Toronto, Toronto, Ontario, Canada
  • Bagshaw, Sean M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background

Infants undergoing cardiopulmonary bypass (CPB) are at high risk of fluid overload, requiring peritoneal dialysis (PD). This systematic review evaluates whether prophylactic PD catheter (PDC) insertion at the time of cardiac surgery improves post-operative outcomes.

Methods

Comprehensive literature search was completed Oct-2020. We identified studies that compared children ≤18 years undergoing cardiac surgery with CPB and receiving prophylactic PDC (inserted intraoperatively or ≤24 hours postoperatively) vs. children who do not undergo prophylactic PDC placement. Data was extracted on population characteristics; perioperative variables; and short-term postoperative outcomes, including time to negative fluid balance (FB); presence and degree of fluid overload; duration of inotropic support and mechanical ventilation; hospital length of stay; and mortality.

Results

Out of 1067 studies, 208 underwent full-text review for eligibility, and 15 were included: 4 randomized controlled trials; 9 cohort studies; and 2 case-control studies. Intervention was prophylactic PDC insertion with passive peritoneal drainage in 6; PD in 7; and passive peritoneal drainage or PD in 2. The comparator group typically received furosemide. Baseline characteristics were heterogeneous for the included studies with respect to age, weight, and illness severity. Surgical procedures performed were also variable within and between studies. Time to negative FB and prevention of fluid overload showed mixed results with some studies favoring prophylactic PDC and others showing no difference. Pooled unadjusted OR for in-hospital mortality was 0.75 (95% CI: 0.05-11.11) (Figure 1). No studies reported serious PDC-related complications. Risk of bias was high in most studies, due to higher illness severity in the intervention groups, small sample size, and observational nature of studies.

Conclusion

Prophylactic PDC insertion is relatively safe in children undergoing cardiac surgery with CPB. Some studies have shown prophylactic PDC improves post-operative outcomes, including time to negative FB and in-hospital mortality; others have shown no difference.