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Aim: To evaluate early peritoneal dialysis (PD) in high risk patients after pediatric cardiac surgery and compare it with standard care of post pediatric cardiac surgery.
Methods: A retrospective study done on patients operated between Jan 2014 and Dec 2018, a total of 1163 pediatric patients underwent different cardiac surgical procedures, and we adopted early peritoneal dialysis protocol since Jan 2014 in a subgroup of patients. This protocol entails routine intraoperative peritoneal dialysis catheter (Peritoneal Dialysis) insertion through the peritoneal lining in the subxiphoid space and starting peritoneal dialysis in the ICU when certain criteria were met, this group of patients was compared to the standard care (Not initiating. to maintain negative fluid balance). The Study groups included 40 patients who had pediatric cardiac surgery, of whom 25 had the standard postoperative care and their mean age was 10.4 ± 6.27 months, the other 15 patients had early peritoneal dialysis (started within 6 hours after surgery) and their mean age was 9.29 ± 5.37 months; where the P value was 0.570.
Results: The mean Body Surface Area (BSA) of the standard group was 0.327 ± 0.059 m2 and in the early peritoneal dialysis group was 0.323 ± 0.054 m²; p-value was 0.805. In the standard peritoneal dialysis group, the mean cross clamp time was 163.12 ± 18.27 minutes and it was 167.73 ± 19.58 hours in the early peritoneal dialysis group and the p value was 0.456. The mean ventilation time in the standard peritoneal dialysis group was 7.82 ± 3.50 days compared to 5.40 ± 2.26 days in the early peritoneal dialysis group, the p value was 0.022. The mortality in the standard group was 4 (16%) and in the early peritoneal dialysis group was 2 (13.3%) and the p value was 0.819.
Conclusion: Initiation of early peritoneal dialysis in selected high-risk patients after pediatric cardiac surgery had beneficial effect on postoperative conditions; it significantly reduces the ventilation time and hence improves the postoperative outcome.