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Safety and utility of passive peritoneal drainage following Fontan palliation

Published online by Cambridge University Press:  04 June 2013

Chaya Pitman-Hunt ,
Kristen L. Richards ,
Ralph E. Delius ,
Henry L. Walters III  and
Christopher W. Mastropietro
Chaya Pitman-Hunt
Affiliation:
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Kristen L. Richards
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Christopher W. Mastropietro*
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
*
Correspondence to: C. W. Mastropietro, Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan, Wayne State University, Carl's Building, 4th floor, 3901 Beaubien Street, Detroit, Michigan 48201, United States of America. Tel: +313 745 7495; Fax: +313 966 0103; E-mail: cmastrop@med.wayne.edu
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Abstract

Objective: Placement of peritoneal drainage catheters intra-operatively has been shown to help prevent fluid overload in children recovering from surgery for two-ventricle heart disease. We aimed to determine whether this practice is also helpful in children recovering from Fontan palliation. Material and methods: A retrospective review was performed on children with single-ventricle anatomy undergoing Fontan palliation at our institution from 2007 to 2011. Variables in those with peritoneal drainage were compared with those without using t-tests, Mann–Whitney U-tests, chi-square tests, or analysis of variance for repeated measures as appropriate. Data were represented as mean with standard deviation unless otherwise noted. Results: A total of 43 children were reviewed, 21 (49%) with peritoneal drainage catheters. No complications from catheter placement occurred. The groups did not differ with regard to cardiopulmonary bypass duration, dominant ventricle, pre-operative haemodynamic data, fenestration use, and initial intensive care unit ventilation index. Central venous pressures, vasoactive medication use, and diuretic use during the first 48 hours were also not statistically different. At 48 hours, the median fluid balance was −9 (interquartile range : −50, +20) in those with peritoneal drainage and +77 cc/kg (interquartile range : +22, +96) in those without (p < 0.001), yet median duration of mechanical ventilation was 40 hours (range: 19–326) in those with peritoneal drainage and 23 hours (range: 9–92) in those without, p = 0.01. Conclusion: Patients with peritoneal drainage recovering from Fontan palliation achieved negative fluid balance as compared with those without peritoneal drainage, although this difference was associated with a longer duration of mechanical ventilation.

Keywords

Congenital heart diseasepaediatricpost-operative careFontan
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 503 - 509
Copyright
Copyright © Cambridge University Press 2013 

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