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European Journal of Cardio-Thoracic Surgery, Vol 5, 258-264, Copyright © 1991 by European Association for Cardio-thoracic Surgery
T Maehara, I Novak, RK Wyse and MJ Elliot
Knowledge of the changes in total body water (TBW) following cardiac
surgery (OHS) in children would be of value in fluid therapy and in
researching the causes and management of capillary leak. We have validated
a bioelectrical impedance technique (BEI) for non-invasive estimation of
TBW in children after OHS. We report the use of this method in a
longitudinal study. Twenty patients (mean age 4.7 years +/- 3.5 (SD), mean
weight (WT) 16.2 kg +/- 1 kg) undergoing a variety of complex OHS
procedures were studied from 1 day preoperatively to 4 days
postoperatively. Anaesthetic and basic bypass (CPB) techniques were
uniform. Six patients underwent CPB at less than 20 degrees C, 10 at 20
degrees - 25 degrees C and 4 at 26 degrees - 33 degrees C. TBW (BEI), core
(ctemp) and peripheral (ptemp) temperatures and fluid balance (TFB) were
recorded at frequent intervals. TBW (by BEI) rose (P less than 0.001)
following CPB in all patients from 62% +/- 9% (SD) body weight
preoperatively to 73% +/- 13% in the ICU (an increase of 11% +/- 5%). TBW
remained significantly elevated until the 3rd postoperative day.
Multivariate analysis (MVA) confirmed that TBW was significantly related to
TFB, but not to ctemp or ptemp. MVA also revealed smaller patient size
(height and weight), younger age and longer CPB time as incremental risk
factors for the rise in TBW. Conclusions: (1) BEI permits the non-invasive
study of TBW in children after OHS, when TBW variation may be considerable.
(2) The smaller the child and the longer the CPB, the greater the rise in
TBW. (3) The technique should be a valuable tool in researching the major
water fluxes associated with CPB in children.
ARTICLES
Perioperative monitoring of total body water by bio-electrical impedance in children undergoing open heart surgery
Hospital for Sick Children, London, UK.
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