Abstract
Purpose
Pediatric post-cardiac surgery patients are at risk for acute kidney injury and intraabdominal
hypertension. The present study assesses indications and outcomes of postoperative
peritoneal dialysis catheter (PDC) placement in this population.
Methods
We retrospectively reviewed single-institution patients who underwent PDC placement
post-cardiac surgery between 1999 and 2011 (n = 55). Baseline, clinical course, and outcome data were recorded pre- and post-PDC.
We used multivariable logistic and Cox analyses to assess factors associated with
mortality.
Results
In-hospital mortality of the study cohort was 67.3% (n = 37). Peritoneal dialysis was performed in 21 patients (38.2%). Five patients (9.1%)
experienced adverse events related to PDC placement. Greater post-PDC decreases in
abdominal girth (adjusted odds ratio [OR] = 2.43; P = 0.02) and BUN (OR = 1.06; P = 0.04) were associated with survival. Additionally, preoperative ventilator independence
(hazard ratio [HR] = 1.18; P < 0.01) and lower creatinine (HR = 8.32; P < 0.01), as well as greater post-PDC decrease in inotrope score (HR = 1.33; P < 0.02) were associated with survival.
Conclusions
In-hospital mortality of the study cohort was 67%. Less severe pre-PDC renal impairment,
increased pre-PDC abdominal girth, and greater post-PDC improvement of abdominal girth,
renal function, and inotrope requirements were associated with survival. Prospective
trials are needed to assess appropriate indications and timing of PDC placement, with
consideration of more aggressive treatment for intraabdominal hypertension.
Key words
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Article info
Publication history
Accepted:
March 8,
2013
Received:
February 23,
2013
Footnotes
☆Institutional review board: Approved, No. M10-11-0575.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
