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Effect of peritoneal dialysis on intra-abdominal pressure and cardio-respiratory function in infants following cardiac surgery

Published online by Cambridge University Press:  21 January 2005

Kevin P. Morris ,
Warwick W. Butt  and
Tom R. Karl
Kevin P. Morris
Affiliation:
Department of Paediatric Intensive Care, Royal Children’s Hospital, Melbourne, Victoria, Australia
Warwick W. Butt
Affiliation:
Department of Paediatric Intensive Care, Royal Children’s Hospital, Melbourne, Victoria, Australia
Tom R. Karl
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia Current address: Division of Cardiothoracic Surgery, UCSF Children’s Hospital, San Francisco, USA
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Abstract

Objective: To investigate the relationship between dialysate volume, intra-abdominal pressure, and cardio-respiratory function in infants following cardiac surgery. Design: Prospective pilot study. Setting: Paediatric intensive care unit. Patients: Six infants undergoing peritoneal dialysis within 24 h of cardiopulmonary bypass. Interventions: Manipulation of the volume of dialysate at levels of 0, 10, 20, and 30 ml/kg in variable order. Measurements and main results: Intra-abdominal pressure was measured at each volume of dialysate via a pressure transducer connected to the dialysis catheter. Haemodynamic data was collected, including cardiac output, which was measured by thermodilution via a 3.5-French gauge catheter placed in the pulmonary arterial pathway. Respiratory data included PaO2, PaCO2, and dynamic compliance. Intra-abdominal pressure increased with increasing volume of dialysate (p < 0.001), though there was considerable variation between patients in the magnitude of increase. Intra-abdominal pressure remained low even with 30 ml/kg in the abdomen. In three infants, intra-abdominal pressure was re-measured in the absence of muscle relaxants, and was found to be higher in each case. No negative effects on cardiac output, markers of delivery of oxygen, or respiratory function were seen even at volumes of 30 ml/kg. Cardiac index was significantly higher with 10 ml/kg than when the abdomen was empty or contained a larger volume (p < 0.05). Conclusions: In this small group of infants, intra-abdominal pressure increased with increasing volumes of dialysate but remained low, even with 30 ml/kg in the abdomen, and was not associated with any deleterious effects on cardio-respiratory performance.

Keywords

Congenital heart diseaselung functioncompliancecardiac output
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 3 , June 2004 , pp. 293 - 298
Copyright
© 2004 Cambridge University Press

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References

Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol 1985; 248: R208–R213.Google Scholar
Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravasular volume expansion. J Trauma 1995; 39: 1071–1075.Google Scholar
Rademaker BM, Odoom JA, de Wit LT, Kalkman CJ, ten Brink SA, Ringers J. Haemodynamic effects of pneumoperitoneum for laparoscopic surgery: a comparison of CO2 with N2O insufflation. Eur J Anaesthiol 1994; 11: 301–306.Google Scholar
Savino JA, Cerabona T, Agarwal N, Byrne D. Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function. Ann Surg 1988; 208: 504–511.Google Scholar
Fischbach M, Desprez P, Donnars F, Geisert J. Hydrostatic intraperitoneal pressure in children on peritoneal dialysis: practical implications. Adv Perit Dial 1994; 10: 294–296.Google Scholar
Fischbach M, Terzic J, Dangelser C, Schneider P, Roger ML, Geisert J. Effect of posture on intraperitoneal pressure and peritoneal permeability in children. Pediatr Nephrol 1998; 12: 311–314.Google Scholar
Ryan CA, Hung O, Soder CM. Hemodynamic effects of peritoneal dialysis in three children following open heart surgery. Pediatr Cardiol 1992; 13: 30–32.Google Scholar
Dittrich S, Vogel M, Dahnert I, Haas NA, Alexi-Meskishvili V, Lange PE. Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants. Intens Care Med 2000; 26: 101–104.Google Scholar
Bunchman TE, Meldrum MK, Meliones JE, Sedman AB, Walters MB, Kershaw DB. Pulmonary function variation in ventilator dependent critically ill infants on peritoneal dialysis. Adv Perit Dial 1992; 8: 75–78.Google Scholar
Robotham JL, Wise RA, Bromberger-Barnea B. Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit Care Med 1985; 13: 803–809.Google Scholar
Takata M, Wise RA, Robotham JL. Effects of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol 1990; 69: 1961–1972.Google Scholar
Werner HA, Wensley DF, Lirenman DS, LeBlanc JG. Peritoneal dialysis in children after cardiopulmonary bypass. J Thorac Cardiovasc Surgery 1997; 113: 64–70.Google Scholar
Cheatham ML. Intra-abdominal hypertension and the abdominal compartment syndrome. New Horizons 1999; 7: 96–115.Google Scholar
Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 1989; 17: 118–121.Google Scholar
Lacey SR, Carris LA, Beyer AJ III, Azizkhan RG. Bladder pressure monitoring significantly enhances care of infants with abdominal wall defects; a prospective clinical study. J Pediatr Surg 1993; 28: 1370–1374.Google Scholar
West JB, Dollery CT, Naimark A. Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol 1964; 19: 713–724.Google Scholar
Guyton RA, Davis SC, Michalik RE, Williams WH, Hather CR Jr. Right heart assist by intermittent abdominal compression after surgery for congenital heart disease. Circulation 1985; 75 (Suppl II): 97–100.Google Scholar
De Waele JJ, Benoit D, Hoste E, Colardyn F. A role for muscle relaxation in patients with abdominal compartment syndrome. Intens Care Med 2003; 29: 332 (letter).Google Scholar
Agrawal A, Nolph KD. Advantages of tidal peritoneal dialysis. Perit Dial Int 2000; 20 (Suppl 2): S98–S100.Google Scholar
Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effects of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 1992; 33: 279–282.Google Scholar