Introduction:

Modified ultrafiltration (MUF) is employed at the termination of cardiopulmonary bypass (CPB) in pediatric and neonatal patients undergoing congenital heart surgery to reduce the accumulation of total body water thus increasing the concentration of red blood cells and the other formed elements in the circulation. Modified ultrafiltration has been reported to remove circulating pro-inflammatory mediators that result in systemic inflammatory response syndrome (SIRS) postoperatively.

Methods:

Four hundred patients undergoing cardiac surgery requiring cardiopulmonary bypass and weighing less than or equal to 12 kg were retrospectively evaluated for the effectiveness of MUF. After the termination of CPB, blood was withdrawn through the aortic cannula and passed through a hemoconcentrator attached to the blood cardioplegia set and returned to the patient through the venous cannula. The entire CPB circuit volume in addition to the patient’s circulating blood volume were concentrated until the hematocrit value displayed on the CDI cuvette within the MUF circuit reached 45% or there was no more volume to safely remove. At the same time a full unit of FFP can be infused as water is being removed, thus maintaining euvolemia.

Results:

MUF was performed in all 400 patients with no MUF-related complications. Following the conclusion of MUF, anecdotal observations included improved surgical hemostasis, improved hemodynamic parameters, decreased transfusion requirements, and decreased ventilator times.

Conclusions:

Complete MUF enables the clinician to safely raise the post-CPB hematocrit to at least 40% while potentially removing mediators that could result in SIRS. In addition a full unit of FFP can be administered while maintaining euvolemia.

中文翻译：

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改良超滤在小儿心脏手术中的安全性和实用性

介绍：

改良超滤 (MUF) 用于接受先天性心脏病手术的儿科和新生儿患者体外循环 (CPB) 的终止，以减少全身水分的积累，从而增加循环中红细胞和其他有形成分的浓度。据报道，改良超滤可去除循环中的促炎介质，这些介质会在术后导致全身炎症反应综合征 (SIRS)。

方法：

对 400 名接受体外循环且体重小于或等于 12 公斤的心脏手术患者进行了 MUF 有效性的回顾性评估。CPB 结束后，血液通过主动脉插管抽出，通过血液心脏停搏器上的血液浓缩器，通过静脉插管返回患者体内。除了患者的循环血量外，整个 CPB 回路体积都被浓缩，直到 MUF 回路内 CDI 比色皿上显示的血细胞比容值达到 45%，或者没有更多的体积可以安全移除。同时，随着水的去除，可以注入完整单位的 FFP，从而维持血容量。

结果：

所有 400 名患者均进行了 MUF，没有出现 MUF 相关并发症。在 MUF 结束后，轶事观察包括改善手术止血、改善血液动力学参数、减少输血需求和减少呼吸机时间。

结论：

完全 MUF 使临床医生能够安全地将 CPB 后血细胞比容提高到至少 40%，同时有可能去除可能导致 SIRS 的介质。此外，可以在维持血容量正常的同时施用完整单位的 FFP。