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High colloid oncotic pressure priming of cardiopulmonary bypass in neonates and infants: implications on haemofiltration, weight gain and renal function

^a Department of Paediatric Cardiology and Congenital Heart Disease, University Children's Hospital, Mathildenstrasse 1, D-79106 Freiburg, Germany
^b Department of Cardiovascular Surgery, University Hospital, Freiburg, Germany
^c Department of Paediatric Cardiology, University Children's Hospital, Erlangen, Germany

Received 30 July 2007; received in revised form 14 May 2008; accepted 19 May 2008.

^_* Corresponding author. Tel.: +49 761 270 4317; fax: +49 761 270 4468. (Email: florian.loeffelbein{at}uniklinik-freiburg.de).

Objective: To evaluate the influence of high colloid oncotic pressure (COP) priming of cardiopulmonary bypass (CPB) on fluid balances, haemofiltration, capillary leakage and renal function in neonates and infants. Methods: Twenty neonates or infants underwent heart surgery using CPB and were randomised in two groups. For group 1 (FFP-group) a blood priming with fresh frozen plasma (FFP, low oncotic pressure) was chosen, for group 2 (HA-group) a blood priming containing FFP and human albumin 20% (HA) to realise higher oncotic pressures was substituted. All patients were monitored before, during and 6 h after CPB. We measured weights, fluid balances, transfusion volumes, colloid oncotic pressures, inflammatory parameters (c-reactive protein, interleukin-6, interleukin-8, thrombocytes, leucocytes) and renal function (creatinine clearances, renal protein losses). Results: Patient's demographics and operational procedures were comparable in both groups with no further differences in operation procedures regarding palliation or correction. Colloid oncotic pressures of the priming solutions were higher in the HA-group (28 mmHg ± 4.9) than in the FFP-group (6 mmHg ± 1.3, p < 0.001). Relative weight gain as a marker of capillary leakage in the HA-group (2% ± 4.5) was significantly lower 6 h post CPB than in the FFP-group (8% ± 8.0, p = 0.015). Haemofiltration rates were higher in the HA-group (569 ml ± 197 vs 282 ml ± 157, p = 0.002) on CPB. There were no differences of creatinine clearances 6 h after the end of CPB. Renal protein losses were elevated in both groups without any inter-group differences during and 6 h after CPB. Conclusion: Addition of concentrated human albumin to priming fluids in paediatric cardiac surgery leads to less weight gain even after CPB. Supplementing paediatric patients undergoing cardiac surgery with concentrated human albumin does not affect renal function more severely than in paediatric patients undergoing cardiac surgery on CPB with blood priming.

Key Words: Cardiopulmonary bypass • Neonates • Colloid oncotic pressure • Haemofiltration • Renal function

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