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
{"title":"对接受心脏手术的新生儿使用腹膜导管的相关结果进行评估：一项多中心研究","authors":"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","doi":"10.1016/j.xjon.2024.03.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>P</em> = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, <em>P</em> = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 275-295"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000688/pdfft?md5=c36f936319a101fe5d6c4b4f8d96cfa9&pid=1-s2.0-S2666273624000688-main.pdf","citationCount":"0","resultStr":"{\"title\":\"An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study\",\"authors\":\"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\",\"doi\":\"10.1016/j.xjon.2024.03.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>P</em> = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, <em>P</em> = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"19 \",\"pages\":\"Pages 275-295\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2666273624000688/pdfft?md5=c36f936319a101fe5d6c4b4f8d96cfa9&pid=1-s2.0-S2666273624000688-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273624000688\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624000688","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study
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.
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