1. An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter studyCentral MessagePerspective
- Author
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David M. Kwiatkowski, MD, MS, Jeffrey A. Alten, MD, Kenneth E. Mah, MD, David T. Selewski, MD, Tia T. Raymond, MD, MBA, Natasha S. Afonso, MD, MPH, Joshua J. Blinder, MD, Matthew T. Coghill, MD, David S. Cooper, MD, MPH, Joshua D. Koch, MD, Catherine D. Krawczeski, MD, David L.S. Morales, MD, Tara M. Neumayr, MD, A.K.M. Fazlur Rahman, PhD, Garrett Reichle, MS, Sarah Tabbutt, MD, PhD, Tennille N. Webb, MD, Santiago Borasino, MD, Huaiyu Zang, David Winlaw, MD, David Bailly, DO, Stuart Goldstein, MD, Katja Gist, DO, Katie L. Brandewie, MD, Priya N. Bhat, MD, John W. Diddle, MD, Muhammad Ghbeis, MD, Parthak Prodhan, MD, Xiomara Garcia, MD, Shannon Ramer, Mindy Albertson, Zahidee Rodriquez, MD, Mary Lukacs, Michael Gaies, MD, Joshua Freytag, Amanda Sammons, Hideat Abraha, John Butcher, Dominic Zanaboni, MD, Joan Sanchez de Toledo, MD, PhD, Yuliya A. Domnina, MD, Lucas Saenz, MD, Tracy Baust, Jane Kluck, RN, Jun Sasaki, MD, Aanish Raees, MD, Erika R. O'Neil, MD, Javier J. Lasa, MD, Patrick A. Phillips, Kristal M. Hock, Kevin Valentine, MD, Sachin Tadphale, MBBS, Jason R. Buckley, MD, Luke Schroeder, MD, Shanelle Clarke, MD, Wenying Zhang, MD, Andrew Smith, MD, Mohammed Absi, MD, David J. Askenazi, MD, David J. Askenazi, Parthak Prodhan, Xiomara Garcia, Shanelle Clarke, Zahidee Rodriquez, Muhammad Ghbeis, Jun Sasaki, Katie L. Brandewie, Katja Gist, Michael Gaies, Aanish Raees, Dominic Zanaboni, Joan Sanchez de Toledo, Yuliya A. Domnina, Lucas Saenz, John W. Diddle, Jane Kluck, Linda Duncan, Rebecca A. Bertrandt, Lisa J. Sosa, Priya N. Bhat, Erika R. O’Neal, Javier J. Lasa, Kevin Valentine, Jason R. Buckley, Luke Schroeder, Tammy Doman, Suzanne Viers, Wenying Zhang, Andrew H. Smith, Sachin Tadphale, Mohammed Absi, and David K. Bailly
- Subjects
acute kidney injury ,fluid overload ,neonatal cardiac surgery ,peritoneal catheter ,peritoneal dialysis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: 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. Methods: 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. Results: 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, P = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, P = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations. Conclusions: 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.
- Published
- 2024
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